Surgical visualization and monitoring

ABSTRACT

A surgical visualization system is disclosed. The surgical visualization system is configured to identify one or more structure(s) and/or determine one or more distances with respect to obscuring tissue and/or the identified structure(s). The surgical visualization system can facilitate avoidance of the identified structure(s) by a surgical device. The surgical visualization system can comprise a first emitter configured to emit a plurality of tissue-penetrating light waves and a second emitter configured to emit structured light onto the surface of tissue. The surgical visualization system can also include an image sensor configured to detect reflected visible light, tissue-penetrating light, and/or structured light. The surgical visualization system can convey information to one or more clinicians regarding the position of one or more hidden identified structures and/or provide one or more proximity indicators. In various instances, a robotic camera of the surgical visualization system can monitor and track one or more tagged structures.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation application claiming priority under35 U.S.C. § 120 to U.S. patent application Ser. No. 16/128,193, titledSURGICAL VISUALIZATION AND MONITORING, filed Sep. 11, 2018, which claimsthe benefit of priority under 35 U.S.C. § 119(e) to U.S. ProvisionalPatent Application Ser. No. 62/698,625, titled DIGITAL SURGERYIMAGING/VISUALIZATION SYSTEM, filed Jul. 16, 2018, the disclosures ofwhich are herein incorporated by reference in their entireties.

BACKGROUND

Surgical systems often incorporate an imaging system, which can allowthe clinician(s) to view the surgical site and/or one or more portionsthereof on one or more displays such as a monitor, for example. Thedisplay(s) can be local and/or remote to a surgical theater. An imagingsystem can include a scope with a camera that views the surgical siteand transmits the view to a display that is viewable by a clinician.Scopes include, but are not limited to, arthroscopes, angioscopes,bronchoscopes, choledochoscopes, colonoscopes, cytoscopes,duodenoscopes, enteroscopes, esophagogastro-duodenoscopes(gastroscopes), endoscopes, laryngoscopes, nasopharyngo-neproscopes,sigmoidoscopes, thoracoscopes, ureteroscopes, and exoscopes. Imagingsystems can be limited by the information that they are able torecognize and/or convey to the clinician(s). For example, certainconcealed structures, physical contours, and/or dimensions within athree-dimensional space may be unrecognizable intraoperatively bycertain imaging systems. Additionally, certain imaging systems may beincapable of communicating and/or conveying certain information to theclinician(s) intraoperatively.

SUMMARY

A surgical visualization system can comprise a robotic tool comprisingan image sensor, wherein the image sensor defines a field of view. Thesurgical visualization can further comprise a display screen; a controlcircuit communicatively coupled to the robotic tool, the image sensor,and the display screen; and a memory communicatively coupled to thecontrol circuit, wherein the memory stores program instructions which,when executed, cause the control circuit to receive a first inputcorresponding to a structure selected for monitoring; receiveinformation from the image sensor related to a position of thestructure; provide a signal to the display screen corresponding to theposition of the structure; and adjust the image sensor to maintain theposition of the structure within the field of view.

A surgical visualization system can comprise a first source configuredto emit a plurality of spectral light waves configured to penetrate atissue, a second source configured to emit a structured light patternonto a surface of the tissue, an image sensor configured to detect atleast one of the reflected plurality of spectral light waves and thereflected structured light pattern, a display screen, and a controlcircuit communicatively coupled to the first source, the second source,the image sensor, and the display screen. The surgical visualizationsystem can further comprise a memory communicatively coupled to thecontrol circuit, wherein the memory stores program instructions which,when executed, cause the control circuit to receive a first inputcorresponding to a structure selected for tracking, cause the firstsource to emit the plurality of spectral light waves, cause the secondsource to emit the structured light pattern, receive information fromthe image sensor corresponding to the structured light pattern on thesurface of the tissue and the spectral light waves reflected from thestructure, identify the structure from the information received by theimage sensor, provide a signal to the display screen corresponding tothe identified structure, and adjust the image sensor when the structureis no longer captured by the image sensor.

A surgical visualization system can comprise an image sensor configuredto image an embedded structure at least partially embedded within avisible structure, wherein the image sensor defines a field of view. Thesurgical visualization system can further comprise a display screen anda control circuit communicatively coupled to the image sensor and thedisplay screen, wherein the control circuit comprises an image overlaycontroller. The surgical visualization system can also comprise a memorycommunicatively coupled to the control circuit, wherein the memorystores program instructions which, when executed, cause the controlcircuit to receive a first input corresponding to the embedded structureselected for monitoring; receive information from the image sensorrelated to a position of the embedded structure; provide a live-feedvideo signal of the visible structure to the image overlay controller;provide a live-feed video signal of the position of the embeddedstructure to the image overlay controller, wherein the image overlaycontroller is configured to overlay the position of the embeddedstructure on top of the visible structure; determine a distance withrespect to the embedded structure; and provide a signal indicative ofthe distance to the display screen.

FIGURES

The novel features of the various aspects are set forth withparticularity in the appended claims. The described aspects, however,both as to organization and methods of operation, may be best understoodby reference to the following description, taken in conjunction with theaccompanying drawings in which:

FIG. 1 is a schematic of a surgical visualization system including animaging device and a surgical device, the surgical visualization systemconfigured to identify a critical structure below a tissue surface,according to at least one aspect of the present disclosure.

FIG. 2 is a schematic of a control system for a surgical visualizationsystem, according to at least one aspect of the present disclosure.

FIG. 2A illustrates a control circuit configured to control aspects of asurgical visualization system, according to at least one aspect of thepresent disclosure.

FIG. 2B illustrates a combinational logic circuit configured to controlaspects of a surgical visualization system, according to at least oneaspect of the present disclosure.

FIG. 2C illustrates a sequential logic circuit configured to controlaspects of a surgical visualization system, according to at least oneaspect of the present disclosure.

FIG. 3 is a schematic depicting triangularization between the surgicaldevice, the imaging device, and the critical structure of FIG. 1 todetermine a depth d_(A) of the critical structure below the tissuesurface, according to at least one aspect of the present disclosure.

FIG. 4 is a schematic of a surgical visualization system configured toidentify a critical structure below a tissue surface, wherein thesurgical visualization system includes a pulsed light source fordetermining a depth d_(A) of the critical structure below the tissuesurface, according to at least one aspect of the present disclosure.

FIG. 5 is a schematic of a surgical visualization system including animaging device and a surgical device, the surgical visualization systemconfigured to identify a critical structure below a tissue surface,according to at least one aspect of the present disclosure.

FIG. 6 is a schematic of a surgical visualization system including athree-dimensional camera, wherein the surgical visualization system isconfigured to identify a critical structure that is embedded withintissue, according to at least one aspect of the present disclosure.

FIGS. 7A and 7B are views of the critical structure taken by thethree-dimensional camera of FIG. 6, in which FIG. 7A is a view from aleft-side lens of the three-dimensional camera and FIG. 7B is a viewfrom a right-side lens of the three-dimensional camera, according to atleast one aspect of the present disclosure.

FIG. 8 is a schematic of the surgical visualization system of FIG. 6, inwhich a camera-to-critical structure distance d_(w) from thethree-dimensional camera to the critical structure can be determined,according to at least one aspect of the present disclosure.

FIG. 9 is a schematic of a surgical visualization system utilizing twocameras to determine the position of an embedded critical structure,according to at least one aspect of the present disclosure.

FIG. 10A is a schematic of a surgical visualization system utilizing acamera that is moved axially between a plurality of known positions todetermine a position of an embedded critical structure, according to atleast one aspect of the present disclosure.

FIG. 10B is a schematic of the surgical visualization system of FIG.10A, in which the camera is moved axially and rotationally between aplurality of known positions to determine a position of the embeddedcritical structure, according to at least one aspect of the presentdisclosure.

FIG. 11 is a schematic of a control system for a surgical visualizationsystem, according to at least one aspect of the present disclosure.

FIG. 12 is a schematic of a structured light source for a surgicalvisualization system, according to at least one aspect of the presentdisclosure.

FIG. 13 is a schematic of a hyperspectral visualization system forimaging terrestrial features or objects, according to at least oneaspect of the present disclosure.

FIG. 14 is a graphical representation of hyperspectral signatures forvarious terrestrial features or objects, according to at least oneaspect of the present disclosure.

FIGS. 15A-15C show an example of a hyperspectral visualization systemfor imaging a fried egg, wherein FIG. 15A is a photograph of the friedegg, FIG. 15B is a graphical representation of hyperspectral signaturesfor an egg yolk portion and an egg white portion of the fried egg, andFIG. 15C is a hyperspectral image (shown in black-and-white) of thefried egg, in which an augmented image differentiates between the eggyolk portion and the egg white portion based on hyperspectral signaturedata, according to at least one aspect of the present disclosure.

FIGS. 16-18 depict illustrative hyperspectral identifying signatures todifferentiate anatomy from obscurants, wherein FIG. 16 is a graphicalrepresentation of a ureter signature versus obscurants, FIG. 17 is agraphical representation of an artery signature versus obscurants, andFIG. 18 is a graphical representation of a nerve signature versusobscurants, according to at least one aspect of the present disclosure.

FIG. 19 is a schematic of a near infrared (NIR) time-of-flightmeasurement system configured to sense distance to a critical anatomicalstructure, the time-of-flight measurement system including a transmitter(emitter) and a receiver (sensor) positioned on a common device,according to at least one aspect of the present disclosure.

FIG. 20 is a schematic of an emitted wave, a received wave, and a delaybetween the emitted wave and the received wave of the NIR time-of-flightmeasurement system of FIG. 19, according to at least one aspect of thepresent disclosure.

FIG. 21 illustrates a NIR time-of-flight measurement system configuredto sense a distance to different structures, the time-of-flightmeasurement system including a transmitter (emitter) and a receiver(sensor) on separate devices, according to one aspect of the presentdisclosure.

FIG. 22A is a display screen of a surgical visualization systemconfigured in a visible mode, according to at least one aspect of thepresent disclosure.

FIG. 22B is the display screen of FIG. 22A when a hidden mode isactivated, according to at least one aspect of the present disclosure.

FIG. 22C is the display screen of FIG. 22A when a combination mode isactivated, according to at least one aspect of the present disclosure.

FIG. 23 is a flowchart depicting an algorithm for a surgicalvisualization system, according to at least one aspect of the presentdisclosure.

FIG. 24A is a display screen of a surgical visualization systemdepicting one or more proximity scales, according to at least one aspectof the present disclosure.

FIG. 24B is the display screen of FIG. 24A depicting one or moreproximity scales, according to at least one aspect of the presentdisclosure.

FIG. 25 is a flowchart depicting an algorithm for a surgicalvisualization system, according to at least one aspect of the presentdisclosure.

FIG. 26 is a flowchart depicting an algorithm for a surgicalvisualization system, according to at least one aspect of the presentdisclosure.

DESCRIPTION

Applicant of the present application also owns the following U.S. PatentApplications, filed on Sep. 11, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 16/128,179, titled SURGICAL        VISUALIZATION PLATFORM, Attorney Docket No. END8605USNP/180230,        now U.S. Pat. No. 11,000,270;    -   U.S. patent application Ser. No. 16/128,191, titled SURGICAL        VISUALIZATION CONTROLS, Attorney Docket No.        END8605USNP1/180230-1, now U.S. Patent Application Publication        No. 2020/0015904;    -   U.S. patent application Ser. No. 16/128,180, titled CONTROLLING        AN EMITTER ASSEMBLY PULSE SEQUENCE, Attorney Docket No.        END8606USNP/180231, now U.S. Patent Application Publication No.        2020/0015900;    -   U.S. patent application Ser. No. 16/128,198, titled COMBINATION        EMITTER AND CAMERA ASSEMBLY, Attorney Docket No.        END8606USNP1/180231-1, now U.S. Pat. No. 11,304,692;    -   U.S. patent application Ser. No. 16/128,207, titled SINGULAR,        EMR SOURCE WITH DUAL OUTPUT EMITTER ASSEMBLY, Attorney Docket        No. END8606USNP2/180231-2, now U.S. Patent Application        Publication No. 2020/0015925;    -   U.S. patent application Ser. No. 16/128,176, titled SURGICAL        VISUALIZATION WITH PROXIMITY TRACKING FEATURES, Attorney Docket        No. END8607USNP/180232, now U.S. Patent Application Publication        No. 2020/0015899;    -   U.S. patent application Ser. No. 16/128,187, titled SURGICAL        VISUALIZATION OF MULTIPLE TARGETS, Attorney Docket No.        END8607USNP1/180232-1, now U.S. Patent Application Publication        No. 2020/0015903;    -   U.S. patent application Ser. No. 16/128,192, titled        VISUALIZATION OF SURGICAL DEVICES, Attorney Docket No.        END8607USNP2/180232-2, now U.S. Pat. No. 10,792,034;    -   U.S. patent application Ser. No. 16/128,163, titled OPERATIVE        COMMUNICATION OF LIGHT, Attorney Docket No. END8608USNP/180233,        now U.S. Pat. No. 11,259,793;    -   U.S. patent application Ser. No. 16/128,197, titled ROBOTIC        LIGHT PROJECTION TOOLS, Attorney Docket No. END8609USNP/180234,        now U.S. Patent Application Publication No. 2020/0015924;    -   U.S. patent application Ser. No. 16/128,164, titled SURGICAL        VISUALIZATION FEEDBACK SYSTEM, Attorney Docket No.        END8610USNP/180235, now U.S. Patent Application Publication No.        2020/0015898;    -   U.S. patent application Ser. No. 16/128,195, titled INTEGRATION        OF IMAGING DATA, Attorney Docket No. END8612USNP/180237, now        U.S. Patent Application Publication No. 2020/0015907;    -   U.S. patent application Ser. No. 16/128,170, titled        ROBOTICALLY-ASSISTED SURGICAL SUTURING SYSTEMS, Attorney Docket        No. END8613USNP/180238, now U.S. Pat. No. 10,925,598;    -   U.S. patent application Ser. No. 16/128,183, titled SAFETY LOGIC        FOR SURGICAL SUTURING SYSTEMS, Attorney Docket No.        END8613USNP1/180238-1, now U.S. Patent Application Publication        No. 2020/0015901;    -   U.S. patent application Ser. No. 16/128,172, titled ROBOTIC        SYSTEM WITH SEPARATE PHOTOACOUSTIC RECEIVER, Attorney Docket No.        END8614USNP/180239, now U.S. Patent Application Publication No.        2020/0015914; and    -   U.S. patent application Ser. No. 16/128,185, titled FORCE SENSOR        THROUGH STRUCTURED LIGHT DEFLECTION, Attorney Docket No.        END8615USNP/180240, now U.S. Patent Application Publication No.        2020/0015902.

Applicant of the present application also owns U.S. Pat. No. 9,072,535,titled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENTARRANGEMENTS, issued Jul. 7, 2015, which is incorporated by referenceherein in its entirety.

Applicant of the present application also owns U.S. Provisional PatentApplication No. 62/611,339, titled ROBOT ASSISTED SURGICAL PLATFORM,filed Dec. 28, 2017, which is incorporated by reference herein in itsentirety.

Applicant of the present application also owns the following U.S. PatentApplications, filed on Mar. 29, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 15/940,627, titled DRIVE        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,676, titled AUTOMATIC        TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,711, titled SENSING        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and    -   U.S. patent application Ser. No. 15/940,722, titled        CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF        MONO-CHROMATIC LIGHT REFRACTIVITY, filed Mar. 29, 2018, which is        incorporated by reference herein in its entirety.

Before explaining various aspects of a surgical visualization platformin detail, it should be noted that the illustrative examples are notlimited in application or use to the details of construction andarrangement of parts illustrated in the accompanying drawings anddescription. The illustrative examples may be implemented orincorporated in other aspects, variations, and modifications, and may bepracticed or carried out in various ways. Further, unless otherwiseindicated, the terms and expressions employed herein have been chosenfor the purpose of describing the illustrative examples for theconvenience of the reader and are not for the purpose of limitationthereof. Also, it will be appreciated that one or more of thefollowing-described aspects, expressions of aspects, and/or examples,can be combined with any one or more of the other following-describedaspects, expressions of aspects, and/or examples.

The present disclosure is directed to a surgical visualization platformthat leverages “digital surgery” to obtain additional information abouta patient's anatomy and/or a surgical procedure. The surgicalvisualization platform is further configured to convey data and/orinformation to one or more clinicians in a helpful manner. For example,various aspects of the present disclosure provide improved visualizationof the patient's anatomy and/or the surgical procedure.

“Digital surgery” can embrace robotic systems, advanced imaging,advanced instrumentation, artificial intelligence, machine learning,data analytics for performance tracking and benchmarking, connectivityboth inside and outside of the operating room (OR), and more. Althoughvarious surgical visualization platforms described herein can be used incombination with a robotic surgical system, surgical visualizationplatforms are not limited to use with a robotic surgical system. Incertain instances, advanced surgical visualization can occur withoutrobotics and/or with limited and/or optional robotic assistance.Similarly, digital surgery can occur without robotics and/or withlimited and/or optional robotic assistance.

In certain instances, a surgical system that incorporates a surgicalvisualization platform may enable smart dissection in order to identifyand avoid critical structures. Critical structures include anatomicalstructures such as a ureter, an artery such as a superior mesentericartery, a vein such as a portal vein, a nerve such as a phrenic nerve,and/or a tumor, among other anatomical structures. In other instances, acritical structure can be a foreign structure in the anatomical field,such as a surgical device, surgical fastener, clip, tack, bougie, band,and/or plate, for example. Critical structures can be determined on apatient-by-patient and/or a procedure-by-procedure basis. Examplecritical structures are further described herein. Smart dissectiontechnology may provide improved intraoperative guidance for dissectionand/or can enable smarter decisions with critical anatomy detection andavoidance technology, for example.

A surgical system incorporating a surgical visualization platform mayalso enable smart anastomosis technologies that provide more consistentanastomoses at optimal location(s) with improved workflow. Cancerlocalization technologies may also be improved with the various surgicalvisualization platforms and procedures described herein. For example,cancer localization technologies can identify and track a cancerlocation, orientation, and its margins. In certain instances, the cancerlocalizations technologies may compensate for movement of a tool, apatient, and/or the patient's anatomy during a surgical procedure inorder to provide guidance back to the point of interest for theclinician.

In certain aspects of the present disclosure, a surgical visualizationplatform may provide improved tissue characterization and/or lymph nodediagnostics and mapping. For example, tissue characterizationtechnologies may characterize tissue type and health without the needfor physical haptics, especially when dissecting and/or placing staplingdevices within the tissue. Certain tissue characterization technologiesdescribed herein may be utilized without ionizing radiation and/orcontrast agents. With respect to lymph node diagnostics and mapping, asurgical visualization platform may preoperatively locate, map, andideally diagnose the lymph system and/or lymph nodes involved incancerous diagnosis and staging, for example.

These and other related topics are described herein and/or in theaforementioned contemporaneously-filed U.S. Patent Applications, whichare incorporated by reference herein in their respective entireties.

During a surgical procedure, the information available to the clinicianvia the “naked eye” and/or an imaging system may provide an incompleteview of the surgical site. For example, certain structures, such asstructures embedded or buried within an organ, can be at least partiallyconcealed or hidden from view. Additionally, certain dimensions and/orrelative distances can be difficult to ascertain with existing sensorsystems and/or difficult for the “naked eye” to perceive. Moreover,certain structures can move preoperatively (e.g. before a surgicalprocedure but after a preoperative scan) and/or intraoperatively. Insuch instances, the clinician can be unable to accurately determine thelocation of a critical structure intraoperatively.

When the position of a critical structure is uncertain and/or when theproximity between the critical structure and a surgical tool is unknown,a clinician's decision-making process can be inhibited. For example, aclinician may avoid certain areas in order to avoid inadvertentdissection of a critical structure; however, the avoided area may beunnecessarily large and/or at least partially misplaced. Due touncertainty and/or overly/excessive exercises in caution, the clinicianmay not access certain desired regions. For example, excess caution maycause a clinician to leave a portion of a tumor and/or other undesirabletissue in an effort to avoid a critical structure even if the criticalstructure is not in the particular area and/or would not be negativelyimpacted by the clinician working in that particular area. In certaininstances, surgical results can be improved with increased knowledgeand/or certainty, which can allow a surgeon to be more accurate and, incertain instances, less conservative/more aggressive with respect toparticular anatomical areas.

In various aspects, the present disclosure provides a surgicalvisualization system for intraoperative identification and avoidance ofcritical structures. In one aspect, the present disclosure provides asurgical visualization system that enables enhanced intraoperativedecision making and improved surgical outcomes. In various aspects, thedisclosed surgical visualization system provides advanced visualizationcapabilities beyond what a clinician sees with the “naked eye” and/orbeyond what an imaging system can recognize and/or convey to theclinician. The various surgical visualization systems can augment andenhance what a clinician is able to know prior to tissue treatment (e.g.dissection) and, thus, may improve outcomes in various instances.

For example, a visualization system can include a first light emitterconfigured to emit a plurality of spectral waves, a second light emitterconfigured to emit a light pattern, and one or more receivers, orsensors, configured to detect visible light, molecular responses to thespectral waves (spectral imaging), and/or the light pattern. Thesurgical visualization system can also include an imaging system and acontrol circuit in signal communication with the receiver(s) and theimaging system. Based on output from the receiver(s), the controlcircuit can determine a geometric surface map, i.e. three-dimensionalsurface topography, of the visible surfaces at the surgical site and oneor more distances with respect to the surgical site. In certaininstances, the control circuit can determine one more distances to an atleast partially concealed structure. Moreover, the imaging system canconvey the geometric surface map and the one or more distances to aclinician. In such instances, an augmented view of the surgical siteprovided to the clinician can provide a representation of the concealedstructure within the relevant context of the surgical site. For example,the imaging system can virtually augment the concealed structure on thegeometric surface map of the concealing and/or obstructing tissuesimilar to a line drawn on the ground to indicate a utility line belowthe surface. Additionally or alternatively, the imaging system canconvey the proximity of one or more surgical tools to the visible andobstructing tissue and/or to the at least partially concealed structureand/or the depth of the concealed structure below the visible surface ofthe obstructing tissue. For example, the visualization system candetermine a distance with respect to the augmented line on the surfaceof the visible tissue and convey the distance to the imaging system.

In various aspects of the present disclosure, a surgical visualizationsystem is disclosed for intraoperative identification and avoidance ofcritical structures. Such a surgical visualization system can providevaluable information to a clinician during a surgical procedure. As aresult, the clinician can confidently maintain momentum throughout thesurgical procedure knowing that the surgical visualization system istracking a critical structure such as a ureter, specific nerves, and/orcritical blood vessels, for example, which may be approached duringdissection, for example. In one aspect, the surgical visualizationsystem can provide an indication to the clinician in sufficient time forthe clinician to pause and/or slow down the surgical procedure andevaluate the proximity to the critical structure to prevent inadvertentdamage thereto. The surgical visualization system can provide an ideal,optimized, and/or customizable amount of information to the clinician toallow the clinician to move confidently and/or quickly through tissuewhile avoiding inadvertent damage to healthy tissue and/or criticalstructure(s) and, thus, to minimize the risk of harm resulting from thesurgical procedure.

FIG. 1 is a schematic of a surgical visualization system 100 accordingto at least one aspect of the present disclosure. The surgicalvisualization system 100 can create a visual representation of acritical structure 101 within an anatomical field. The surgicalvisualization system 100 can be used for clinical analysis and/ormedical intervention, for example. In certain instances, the surgicalvisualization system 100 can be used intraoperatively to providereal-time, or near real-time, information to the clinician regardingproximity data, dimensions, and/or distances during a surgicalprocedure. The surgical visualization system 100 is configured forintraoperative identification of critical structure(s) and/or tofacilitate the avoidance of the critical structure(s) 101 by a surgicaldevice. For example, by identifying the critical structure 101, aclinician can avoid maneuvering a surgical device around the criticalstructure 101 and/or a region in a predefined proximity of the criticalstructure 101 during a surgical procedure. The clinician can avoiddissection of and/or near a vein, artery, nerve, and/or vessel, forexample, identified as the critical structure 101, for example. Invarious instances, the critical structure 101 can be determined on apatient-by-patient and/or a procedure-by-procedure basis.

The surgical visualization system 100 incorporates tissue identificationand geometric surface mapping in combination with a distance sensorsystem 104. In combination, these features of the surgical visualizationsystem 100 can determine a position of a critical structure 101 withinthe anatomical field and/or the proximity of a surgical device 102 tothe surface 105 of the visible tissue and/or to the critical structure101. Moreover, the surgical visualization system 100 includes an imagingsystem that includes an imaging device 120, such as a camera, forexample, configured to provide real-time views of the surgical site. Invarious instances, the imaging device 120 is a spectral camera (e.g. ahyperspectral camera, multispectral camera, or selective spectralcamera), which is configured to detect reflected spectral waveforms andgenerate a spectral cube of images based on the molecular response tothe different wavelengths. Views from the imaging device 120 can beprovided to a clinician and, in various aspects of the presentdisclosure, can be augmented with additional information based on thetissue identification, landscape mapping, and the distance sensor system104. In such instances, the surgical visualization system 100 includes aplurality of subsystems—an imaging subsystem, a surface mappingsubsystem, a tissue identification subsystem, and/or a distancedetermining subsystem. These subsystems can cooperate tointraoperatively provide advanced data synthesis and integratedinformation to the clinician(s).

The imaging device can include a camera or imaging sensor that isconfigured to detect visible light, spectral light waves (visible orinvisible), and a structured light pattern (visible or invisible), forexample. In various aspects of the present disclosure, the imagingsystem can include an imaging device such as an endoscope, for example.Additionally or alternatively, the imaging system can include an imagingdevice such as an arthroscope, angioscope, bronchoscope,choledochoscope, colonoscope, cytoscope, duodenoscope, enteroscope,esophagogastro-duodenoscope (gastroscope), laryngoscope,nasopharyngo-neproscope, sigmoidoscope, thoracoscope, ureteroscope, orexoscope, for example. In other instances, such as in open surgeryapplications, the imaging system may not include a scope.

In various aspects of the present disclosure, the tissue identificationsubsystem can be achieved with a spectral imaging system. The spectralimaging system can rely on hyperspectral imaging, multispectral imaging,or selective spectral imaging, for example. Hyperspectral imaging oftissue is further described in U.S. Pat. No. 9,274,047, titled SYSTEMAND METHOD FOR GROSS ANATOMIC PATHOLOGY USING HYPERSPECTRAL IMAGING,issued Mar. 1, 2016, which is incorporated by reference herein in itsentirety.

In various aspect of the present disclosure, the surface mappingsubsystem can be achieved with a light pattern system, as furtherdescribed herein. The use of a light pattern (or structured light) forsurface mapping is known. Known surface mapping techniques can beutilized in the surgical visualization systems described herein.

Structured light is the process of projecting a known pattern (often agrid or horizontal bars) on to a surface. U.S. Patent ApplicationPublication No. 2017/0055819, titled SET COMPRISING A SURGICALINSTRUMENT, published Mar. 2, 2017, and U.S. Patent ApplicationPublication No. 2017/0251900, titled DEPICTION SYSTEM, published Sep. 7,2017, disclose a surgical system comprising a light source and aprojector for projecting a light pattern. U.S. Patent ApplicationPublication No. 2017/0055819, titled SET COMPRISING A SURGICALINSTRUMENT, published Mar. 2, 2017, and U.S. Patent ApplicationPublication No. 2017/0251900, titled DEPICTION SYSTEM, published Sep. 7,2017, are incorporated by reference herein in their respectiveentireties.

In various aspects of the present disclosure, the distance determiningsystem can be incorporated into the surface mapping system. For example,structured light can be utilized to generate a three-dimensional virtualmodel of the visible surface and determine various distances withrespect to the visible surface. Additionally or alternatively, thedistance determining system can rely on time-of-flight measurements todetermine one or more distances to the identified tissue (or otherstructures) at the surgical site.

FIG. 2 is a schematic diagram of a control system 133, which can beutilized with the surgical visualization system 100. The control system133 includes a control circuit 132 in signal communication with a memory134. The memory 134 stores instructions executable by the controlcircuit 132 to determine and/or recognize critical structures (e.g. thecritical structure 101 in FIG. 1), determine and/or compute one or moredistances and/or three-dimensional digital representations, and tocommunicate certain information to one or more clinicians. For example,the memory 134 stores surface mapping logic 136, imaging logic 138,tissue identification logic 140, or distance determining logic 141 orany combinations of the logic 136, 138, 140, and 141. The control system133 also includes an imaging system 142 having one or more cameras 144(like the imaging device 120 in FIG. 1), one or more displays 146, orone or more controls 148 or any combinations of these elements. Thecamera 144 can include one or more image sensors 135 to receive signalsfrom various light sources emitting light at various visible andinvisible spectra (e.g. visible light, spectral imagers,three-dimensional lens, among others). The display 146 can include oneor more screens or monitors for depicting real, virtual, and/orvirtually-augmented images and/or information to one or more clinicians.

In various aspects, the heart of the camera 144 is the image sensor 135.Generally, modern image sensors 135 are solid-state electronic devicescontaining up to millions of discrete photodetector sites called pixels.The image sensor 135 technology falls into one of two categories:Charge-Coupled Device (CCD) and Complementary Metal Oxide Semiconductor(CMOS) imagers and more recently, short-wave infrared (SWIR) is anemerging technology in imaging. Another type of image sensor 135 employsa hybrid CCD/CMOS architecture (sold under the name “sCMOS”) andconsists of CMOS readout integrated circuits (ROICs) that are bumpbonded to a CCD imaging substrate. CCD and CMOS image sensors 135 aresensitive to wavelengths from approximately 350-1050 nm, although therange is usually given from 400-1000 nm. CMOS sensors are, in general,more sensitive to IR wavelengths than CCD sensors. Solid state imagesensors 135 are based on the photoelectric effect and, as a result,cannot distinguish between colors. Accordingly, there are two types ofcolor CCD cameras: single chip and three-chip. Single chip color CCDcameras offer a common, low-cost imaging solution and use a mosaic (e.g.Bayer) optical filter to separate incoming light into a series of colorsand employ an interpolation algorithm to resolve full color images. Eachcolor is, then, directed to a different set of pixels. Three-chip colorCCD cameras provide higher resolution by employing a prism to directeach section of the incident spectrum to a different chip. More accuratecolor reproduction is possible, as each point in space of the object hasseparate RGB intensity values, rather than using an algorithm todetermine the color. Three-chip cameras offer extremely highresolutions.

The control system 133 also includes a spectral light source 150 and astructured light source 152. In certain instances, a single source canbe pulsed to emit wavelengths of light in the spectral light source 150range and wavelengths of light in the structured light source 152 range.Alternatively, a single light source can be pulsed to provide light inthe invisible spectrum (e.g. infrared spectral light) and wavelengths oflight on the visible spectrum. The spectral light source 150 can be ahyperspectral light source, a multispectral light source, and/or aselective spectral light source, for example. In various instances, thetissue identification logic 140 can identify critical structure(s) viadata from the spectral light source 150 received by the image sensor 135portion of the camera 144. The surface mapping logic 136 can determinethe surface contours of the visible tissue based on reflected structuredlight. With time-of-flight measurements, the distance determining logic141 can determine one or more distance(s) to the visible tissue and/orthe critical structure 101. One or more outputs from the surface mappinglogic 136, the tissue identification logic 140, and the distancedetermining logic 141, can be provided to the imaging logic 138, andcombined, blended, and/or overlaid to be conveyed to a clinician via thedisplay 146 of the imaging system 142.

The description now turns briefly to FIGS. 2A-2C to describe variousaspects of the control circuit 132 for controlling various aspects ofthe surgical visualization system 100. Turning to FIG. 2A, there isillustrated a control circuit 400 configured to control aspects of thesurgical visualization system 100, according to at least one aspect ofthis disclosure. The control circuit 400 can be configured to implementvarious processes described herein. The control circuit 400 may comprisea microcontroller comprising one or more processors 402 (e.g.,microprocessor, microcontroller) coupled to at least one memory circuit404. The memory circuit 404 stores machine-executable instructions that,when executed by the processor 402, cause the processor 402 to executemachine instructions to implement various processes described herein.The processor 402 may be any one of a number of single-core or multicoreprocessors known in the art. The memory circuit 404 may comprisevolatile and non-volatile storage media. The processor 402 may includean instruction processing unit 406 and an arithmetic unit 408. Theinstruction processing unit may be configured to receive instructionsfrom the memory circuit 404 of this disclosure.

FIG. 2B illustrates a combinational logic circuit 410 configured tocontrol aspects of the surgical visualization system 100, according toat least one aspect of this disclosure. The combinational logic circuit410 can be configured to implement various processes described herein.The combinational logic circuit 410 may comprise a finite state machinecomprising a combinational logic 412 configured to receive dataassociated with the surgical instrument or tool at an input 414, processthe data by the combinational logic 412, and provide an output 416.

FIG. 2C illustrates a sequential logic circuit 420 configured to controlaspects of the surgical visualization system 100, according to at leastone aspect of this disclosure. The sequential logic circuit 420 or thecombinational logic 422 can be configured to implement various processesdescribed herein. The sequential logic circuit 420 may comprise a finitestate machine. The sequential logic circuit 420 may comprise acombinational logic 422, at least one memory circuit 424, and a clock429, for example. The at least one memory circuit 424 can store acurrent state of the finite state machine. In certain instances, thesequential logic circuit 420 may be synchronous or asynchronous. Thecombinational logic 422 is configured to receive data associated with asurgical device or system from an input 426, process the data by thecombinational logic 422, and provide an output 428. In other aspects,the circuit may comprise a combination of a processor (e.g., processor402 in FIG. 2A) and a finite state machine to implement variousprocesses herein. In other aspects, the finite state machine maycomprise a combination of a combinational logic circuit (e.g.,combinational logic circuit 410, FIG. 2B) and the sequential logiccircuit 420.

Referring again to the surgical visualization system 100 in FIG. 1, thecritical structure 101 can be an anatomical structure of interest. Forexample, the critical structure 101 can be a ureter, an artery such as asuperior mesenteric artery, a vein such as a portal vein, a nerve suchas a phrenic nerve, and/or a tumor, among other anatomical structures.In other instances, the critical structure 101 can be a foreignstructure in the anatomical field, such as a surgical device, surgicalfastener, clip, tack, bougie, band, and/or plate, for example. Examplecritical structures are further described herein and in theaforementioned contemporaneously-filed U.S. Patent Applications,including U.S. patent application Ser. No. 16/128,192, titledVISUALIZATION OF SURGICAL DEVICES, now U.S. Pat. No. 10,792,034, forexample, which are incorporated by reference herein in their respectiveentireties.

In one aspect, the critical structure 101 may be embedded in tissue 103.Stated differently, the critical structure 101 may be positioned belowthe surface 105 of the tissue 103. In such instances, the tissue 103conceals the critical structure 101 from the clinician's view. Thecritical structure 101 is also obscured from the view of the imagingdevice 120 by the tissue 103. The tissue 103 can be fat, connectivetissue, adhesions, and/or organs, for example. In other instances, thecritical structure 101 can be partially obscured from view.

FIG. 1 also depicts the surgical device 102. The surgical device 102includes an end effector having opposing jaws extending from the distalend of the shaft of the surgical device 102. The surgical device 102 canbe any suitable surgical device such as, for example, a dissector, astapler, a grasper, a clip applier, and/or an energy device includingmono-polar probes, bi-polar probes, ablation probes, and/or anultrasonic end effector. Additionally or alternatively, the surgicaldevice 102 can include another imaging or diagnostic modality, such asan ultrasound device, for example. In one aspect of the presentdisclosure, the surgical visualization system 100 can be configured toachieve identification of one or more critical structures 101 and theproximity of the surgical device 102 to the critical structure(s) 101.

The imaging device 120 of the surgical visualization system 100 isconfigured to detect light at various wavelengths, such as, for example,visible light, spectral light waves (visible or invisible), and astructured light pattern (visible or invisible). The imaging device 120may include a plurality of lenses, sensors, and/or receivers fordetecting the different signals. For example, the imaging device 120 canbe a hyperspectral, multispectral, or selective spectral camera, asfurther described herein. The imaging device 120 can also include awaveform sensor 122 (such as a spectral image sensor, detector, and/orthree-dimensional camera lens). For example, the imaging device 120 caninclude a right-side lens and a left-side lens used together to recordtwo two-dimensional images at the same time and, thus, generate athree-dimensional image of the surgical site, render a three-dimensionalimage of the surgical site, and/or determine one or more distances atthe surgical site. Additionally or alternatively, the imaging device 120can be configured to receive images indicative of the topography of thevisible tissue and the identification and position of hidden criticalstructures, as further described herein. For example, the field of viewof the imaging device 120 can overlap with a pattern of light(structured light) on the surface 105 of the tissue, as shown in FIG. 1.

In one aspect, the surgical visualization system 100 may be incorporatedinto a robotic system 110. For example, the robotic system 110 mayinclude a first robotic arm 112 and a second robotic arm 114. Therobotic arms 112, 114 include rigid structural members 116 and joints118, which can include servomotor controls. The first robotic arm 112 isconfigured to maneuver the surgical device 102, and the second roboticarm 114 is configured to maneuver the imaging device 120. A roboticcontrol unit can be configured to issue control motions to the roboticarms 112, 114, which can affect the surgical device 102 and the imagingdevice 120, for example.

The surgical visualization system 100 also includes an emitter 106,which is configured to emit a pattern of light, such as stripes, gridlines, and/or dots, to enable the determination of the topography orlandscape of the surface 105. For example, projected light arrays 130can be used for three-dimensional scanning and registration on thesurface 105. The projected light arrays 130 can be emitted from theemitter 106 located on the surgical device 102 and/or one of the roboticarms 112, 114 and/or the imaging device 120, for example. In one aspect,the projected light array 130 is employed to determine the shape definedby the surface 105 of the tissue 103 and/or the motion of the surface105 intraoperatively. The imaging device 120 is configured to detect theprojected light arrays 130 reflected from the surface 105 to determinethe topography of the surface 105 and various distances with respect tothe surface 105.

In one aspect, the imaging device 120 also may include an opticalwaveform emitter 123 that is configured to emit electromagneticradiation 124 (NIR photons) that can penetrate the surface 105 of thetissue 103 and reach the critical structure 101. The imaging device 120and the optical waveform emitter 123 thereon can be positionable by therobotic arm 114. A corresponding waveform sensor 122 (an image sensor,spectrometer, or vibrational sensor, for example) on the imaging device120 is configured to detect the effect of the electromagnetic radiationreceived by the waveform sensor 122. The wavelengths of theelectromagnetic radiation 124 emitted by the optical waveform emitter123 can be configured to enable the identification of the type ofanatomical and/or physical structure, such as the critical structure101. The identification of the critical structure 101 can beaccomplished through spectral analysis, photo-acoustics, and/orultrasound, for example. In one aspect, the wavelengths of theelectromagnetic radiation 124 may be variable. The waveform sensor 122and optical waveform emitter 123 may be inclusive of a multispectralimaging system and/or a selective spectral imaging system, for example.In other instances, the waveform sensor 122 and optical waveform emitter123 may be inclusive of a photoacoustic imaging system, for example. Inother instances, the optical waveform emitter 123 can be positioned on aseparate surgical device from the imaging device 120.

The surgical visualization system 100 also may include the distancesensor system 104 configured to determine one or more distances at thesurgical site. In one aspect, the time-of-flight distance sensor system104 may be a time-of-flight distance sensor system that includes anemitter, such as the emitter 106, and a receiver 108, which can bepositioned on the surgical device 102. In other instances, thetime-of-flight emitter can be separate from the structured lightemitter. In one general aspect, the emitter 106 portion of thetime-of-flight distance sensor system 104 may include a very tiny lasersource and the receiver 108 portion of the time-of-flight distancesensor system 104 may include a matching sensor. The time-of-flightdistance sensor system 104 can detect the “time of flight,” or how longthe laser light emitted by the emitter 106 has taken to bounce back tothe sensor portion of the receiver 108. Use of a very narrow lightsource in the emitter 106 enables the distance sensor system 104 todetermining the distance to the surface 105 of the tissue 103 directlyin front of the distance sensor system 104. Referring still to FIG. 1,d_(e) is the emitter-to-tissue distance from the emitter 106 to thesurface 105 of the tissue 103 and d_(t) is the device-to-tissue distancefrom the distal end of the surgical device 102 to the surface 105 of thetissue. The distance sensor system 104 can be employed to determine theemitter-to-tissue distance d_(e). The device-to-tissue distance d_(t) isobtainable from the known position of the emitter 106 on the shaft ofthe surgical device 102 relative to the distal end of the surgicaldevice 102. In other words, when the distance between the emitter 106and the distal end of the surgical device 102 is known, thedevice-to-tissue distance d_(t) can be determined from theemitter-to-tissue distance d_(e). In certain instances, the shaft of thesurgical device 102 can include one or more articulation joints, and canbe articulatable with respect to the emitter 106 and the jaws. Thearticulation configuration can include a multi-joint vertebrae-likestructure, for example. In certain instances, a three-dimensional cameracan be utilized to triangulate one or more distances to the surface 105.

In various instances, the receiver 108 for the time-of-flight distancesensor system 104 can be mounted on a separate surgical device insteadof the surgical device 102. For example, the receiver 108 can be mountedon a cannula or trocar through which the surgical device 102 extends toreach the surgical site. In still other instances, the receiver 108 forthe time-of-flight distance sensor system 104 can be mounted on aseparate robotically-controlled arm (e.g. the robotic arm 114), on amovable arm that is operated by another robot, and/or to an operatingroom (OR) table or fixture. In certain instances, the imaging device 120includes the time-of-flight receiver 108 to determine the distance fromthe emitter 106 to the surface 105 of the tissue 103 using a linebetween the emitter 106 on the surgical device 102 and the imagingdevice 120. For example, the distance d_(e) can be triangulated based onknown positions of the emitter 106 (on the surgical device 102) and thereceiver 108 (on the imaging device 120) of the time-of-flight distancesensor system 104. The three-dimensional position of the receiver 108can be known and/or registered to the robot coordinate planeintraoperatively.

In certain instances, the position of the emitter 106 of thetime-of-flight distance sensor system 104 can be controlled by the firstrobotic arm 112 and the position of the receiver 108 of thetime-of-flight distance sensor system 104 can be controlled by thesecond robotic arm 114. In other instances, the surgical visualizationsystem 100 can be utilized apart from a robotic system. In suchinstances, the distance sensor system 104 can be independent of therobotic system.

In certain instances, one or more of the robotic arms 112, 114 may beseparate from a main robotic system used in the surgical procedure. Atleast one of the robotic arms 112, 114 can be positioned and registeredto a particular coordinate system without a servomotor control. Forexample, a closed-loop control system and/or a plurality of sensors forthe robotic arms 110 can control and/or register the position of therobotic arm(s) 112, 114 relative to the particular coordinate system.Similarly, the position of the surgical device 102 and the imagingdevice 120 can be registered relative to a particular coordinate system.

Referring still to FIG. 1, d_(w) is the camera-to-critical structuredistance from the optical waveform emitter 123 located on the imagingdevice 120 to the surface of the critical structure 101, and d_(A) isthe depth of the critical structure 101 below the surface 105 of thetissue 103 (i.e., the distance between the portion of the surface 105closest to the surgical device 102 and the critical structure 101). Invarious aspects, the time-of-flight of the optical waveforms emittedfrom the optical waveform emitter 123 located on the imaging device 120can be configured to determine the camera-to-critical structure distanced_(w). The use of spectral imaging in combination with time-of-flightsensors is further described herein. Moreover, referring now to FIG. 3,in various aspects of the present disclosure, the depth d_(A) of thecritical structure 101 relative to the surface 105 of the tissue 103 canbe determined by triangulating from the distance d_(w) and knownpositions of the emitter 106 on the surgical device 102 and the opticalwaveform emitter 123 on the imaging device 120 (and, thus, the knowndistance d_(x) therebetween) to determine the distance d_(y), which isthe sum of the distances d_(e) and d_(A).

Additionally or alternatively, time-of-flight from the optical waveformemitter 123 can be configured to determine the distance from the opticalwaveform emitter 123 to the surface 105 of the tissue 103. For example,a first waveform (or range of waveforms) can be utilized to determinethe camera-to-critical structure distance d_(w) and a second waveform(or range of waveforms) can be utilized to determine the distance to thesurface 105 of the tissue 103. In such instances, the differentwaveforms can be utilized to determine the depth of the criticalstructure 101 below the surface 105 of the tissue 103.

Additionally or alternatively, in certain instances, the distance d_(A)can be determined from an ultrasound, a registered magnetic resonanceimaging (MRI) or computerized tomography (CT) scan. In still otherinstances, the distance d_(A) can be determined with spectral imagingbecause the detection signal received by the imaging device can varybased on the type of material. For example, fat can decrease thedetection signal in a first way, or a first amount, and collagen candecrease the detection signal in a different, second way, or a secondamount.

Referring now to a surgical visualization system 160 in FIG. 4, in whicha surgical device 162 includes the optical waveform emitter 123 and thewaveform sensor 122 that is configured to detect the reflectedwaveforms. The optical waveform emitter 123 can be configured to emitwaveforms for determining the distances d_(t) and d_(w) from a commondevice, such as the surgical device 162, as further described herein. Insuch instances, the distance d_(A) from the surface 105 of the tissue103 to the surface of the critical structure 101 can be determined asfollows:

d _(A) =d _(w) −d _(t).

As disclosed herein, various information regarding visible tissue,embedded critical structures, and surgical devices can be determined byutilizing a combination approach that incorporates one or moretime-of-flight distance sensors, spectral imaging, and/or structuredlight arrays in combination with an image sensor configured to detectthe spectral wavelengths and the structured light arrays. Moreover, theimage sensor can be configured to receive visible light and, thus,provide images of the surgical site to an imaging system. Logic oralgorithms are employed to discern the information received from thetime-of-flight sensors, spectral wavelengths, structured light, andvisible light and render three-dimensional images of the surface tissueand underlying anatomical structures. In various instances, the imagingdevice 120 can include multiple image sensors.

The camera-to-critical structure distance d_(w) can also be detected inone or more alternative ways. In one aspect, a fluoroscopy visualizationtechnology, such as fluorescent indosciedine green (ICG), for example,can be utilized to illuminate a critical structure 201, as shown inFIGS. 6-8. A camera 220 can include two optical waveforms sensors 222,224, which take simultaneous left-side and right-side images of thecritical structure 201 (FIGS. 7A and 7B). In such instances, the camera220 can depict a glow of the critical structure 201 below the surface205 of the tissue 203, and the distance d_(w) can be determined by theknown distance between the sensors 222 and 224. In certain instances,distances can be determined more accurately by utilizing more than onecamera or by moving a camera between multiple locations. In certainaspects, one camera can be controlled by a first robotic arm and asecond camera by another robotic arm. In such a robotic system, onecamera can be a follower camera on a follower arm, for example. Thefollower arm, and camera thereon, can be programmed to track the othercamera and to maintain a particular distance and/or lens angle, forexample.

In still other aspects, the surgical visualization system 100 may employtwo separate waveform receivers (i.e. cameras/image sensors) todetermine d_(w). Referring now to FIG. 9, if a critical structure 301 orthe contents thereof (e.g. a vessel or the contents of the vessel) canemit a signal 302, such as with fluoroscopy, then the actual locationcan be triangulated from two separate cameras 320 a, 320 b at knownlocations.

In another aspect, referring now to FIGS. 10A and 10B, a surgicalvisualization system may employ a dithering or moving camera 440 todetermine the distance d_(w). The camera 440 is robotically-controlledsuch that the three-dimensional coordinates of the camera 440 at thedifferent positions are known. In various instances, the camera 440 canpivot at a cannula or patient interface. For example, if a criticalstructure 401 or the contents thereof (e.g. a vessel or the contents ofthe vessel) can emit a signal, such as with fluoroscopy, for example,then the actual location can be triangulated from the camera 440 movedrapidly between two or more known locations. In FIG. 10A, the camera 440is moved axially along an axis A. More specifically, the camera 440translates a distance d₁ closer to the critical structure 401 along theaxis A to the location indicated as a location 440′, such as by movingin and out on a robotic arm. As the camera 440 moves the distance d₁ andthe size of view change with respect to the critical structure 401, thedistance to the critical structure 401 can be calculated. For example, a4.28 mm axial translation (the distance d₁) can correspond to an angleθ₁ of 6.28 degrees and an angle θ₂ of 8.19 degrees. Additionally oralternatively, the camera 440 can rotate or sweep along an arc betweendifferent positions. Referring now to FIG. 10B, the camera 440 is movedaxially along the axis A and is rotated an angle θ₃ about the axis A. Apivot point 442 for rotation of the camera 440 is positioned at thecannula/patient interface. In FIG. 10B, the camera 440 is translated androtated to a location 440″. As the camera 440 moves and the edge of viewchanges with respect to the critical structure 401, the distance to thecritical structure 401 can be calculated. In FIG. 10B, a distance d₂ canbe 9.01 mm, for example, and the angle θ₃ can be 0.9 degrees, forexample.

FIG. 5 depicts a surgical visualization system 500, which is similar tothe surgical visualization system 100 in many respects. In variousinstances, the surgical visualization system 500 can be a furtherexemplification of the surgical visualization system 100. Similar to thesurgical visualization system 100, the surgical visualization system 500includes a surgical device 502 and an imaging device 520. The imagingdevice 520 includes a spectral light emitter 523, which is configured toemit spectral light in a plurality of wavelengths to obtain a spectralimage of hidden structures, for example. The imaging device 520 can alsoinclude a three-dimensional camera and associated electronic processingcircuits in various instances. The surgical visualization system 500 isshown being utilized intraoperatively to identify and facilitateavoidance of certain critical structures, such as a ureter 501 a andvessels 501 b in an organ 503 (the uterus in this example), that are notvisible on the surface.

The surgical visualization system 500 is configured to determine anemitter-to-tissue distance d_(e) from an emitter 506 on the surgicaldevice 502 to a surface 505 of the uterus 503 via structured light. Thesurgical visualization system 500 is configured to extrapolate adevice-to-tissue distance d_(t) from the surgical device 502 to thesurface 505 of the uterus 503 based on the emitter-to-tissue distanced_(e). The surgical visualization system 500 is also configured todetermine a tissue-to-ureter distance d_(A) from the ureter 501 a to thesurface 505 and a camera-to ureter distance d_(w) from the imagingdevice 520 to the ureter 501 a. As described herein with respect to FIG.1, for example, the surgical visualization system 500 can determine thedistance d_(w) with spectral imaging and time-of-flight sensors, forexample. In various instances, the surgical visualization system 500 candetermine (e.g. triangulate) the tissue-to-ureter distance d_(A) (ordepth) based on other distances and/or the surface mapping logicdescribed herein.

Referring now to FIG. 11, where a schematic of a control system 600 fora surgical visualization system, such as the surgical visualizationsystem 100, for example, is depicted. The control system 600 is aconversion system that integrates spectral signature tissueidentification and structured light tissue positioning to identifycritical structures, especially when those structures are obscured byother tissue, such as fat, connective tissue, blood, and/or otherorgans, for example. Such technology could also be useful for detectingtissue variability, such as differentiating tumors and/or non-healthytissue from healthy tissue within an organ.

The control system 600 is configured for implementing a hyperspectralimaging and visualization system in which a molecular response isutilized to detect and identify anatomy in a surgical field of view. Thecontrol system 600 includes a conversion logic circuit 648 to converttissue data to surgeon usable information. For example, the variablereflectance based on wavelengths with respect to obscuring material canbe utilized to identify the critical structure in the anatomy. Moreover,the control system 600 combines the identified spectral signature andthe structural light data in an image. For example, the control system600 can be employed to create of three-dimensional data set for surgicaluse in a system with augmentation image overlays. Techniques can beemployed both intraoperatively and preoperatively using additionalvisual information. In various instances, the control system 600 isconfigured to provide warnings to a clinician when in the proximity ofone or more critical structures. Various algorithms can be employed toguide robotic automation and semi-automated approaches based on thesurgical procedure and proximity to the critical structure(s).

A projected array of lights is employed to determine tissue shape andmotion intraoperatively. Alternatively, flash Lidar may be utilized forsurface mapping of the tissue.

The control system 600 is configured to detect the critical structure(s)and provide an image overlay of the critical structure and measure thedistance to the surface of the visible tissue and the distance to theembedded/buried critical structure(s). In other instances, the controlsystem 600 can measure the distance to the surface of the visible tissueor detect the critical structure(s) and provide an image overlay of thecritical structure.

The control system 600 includes a spectral control circuit 602. Thespectral control circuit 602 can be a field programmable gate array(FPGA) or another suitable circuit configuration as described herein inconnection with FIGS. 2A-2C, for example. The spectral control circuit602 includes a processor 604 to receive video input signals from a videoinput processor 606. The processor 604 can be configured forhyperspectral processing and can utilize C/C++ code, for example. Thevideo input processor 606 receives video-in of control (metadata) datasuch as shutter time, wave length, and sensor analytics, for example.The processor 604 is configured to process the video input signal fromthe video input processor 606 and provide a video output signal to avideo output processor 608, which includes a hyperspectral video-out ofinterface control (metadata) data, for example. The video outputprocessor 608 provides the video output signal to an image overlaycontroller 610.

The video input processor 606 is coupled to a camera 612 at the patientside via a patient isolation circuit 614. As previously discussed, thecamera 612 includes a solid state image sensor 634. The patientisolation circuit can include a plurality of transformers so that thepatient is isolated from other circuits in the system. The camera 612receives intraoperative images through optics 632 and the image sensor634. The image sensor 634 can include a CMOS image sensor, for example,or may include any of the image sensor technologies discussed herein inconnection with FIG. 2, for example. In one aspect, the camera 612outputs images in 14 bit/pixel signals. It will be appreciated thathigher or lower pixel resolutions may be employed without departing fromthe scope of the present disclosure. The isolated camera output signal613 is provided to a color RGB fusion circuit 616, which employs ahardware register 618 and a Nios2 co-processor 620 to process the cameraoutput signal 613. A color RGB fusion output signal is provided to thevideo input processor 606 and a laser pulsing control circuit 622.

The laser pulsing control circuit 622 controls a laser light engine 624.The laser light engine 624 outputs light in a plurality of wavelengths(λ₁, λ₂, λ₃ . . . λ_(n)) including near infrared (NIR). The laser lightengine 624 can operate in a plurality of modes. In one aspect, the laserlight engine 624 can operate in two modes, for example. In a first mode,e.g. a normal operating mode, the laser light engine 624 outputs anilluminating signal. In a second mode, e.g. an identification mode, thelaser light engine 624 outputs RGBG and NIR light. In various instances,the laser light engine 624 can operate in a polarizing mode.

Light output 626 from the laser light engine 624 illuminates targetedanatomy in an intraoperative surgical site 627. The laser pulsingcontrol circuit 622 also controls a laser pulse controller 628 for alaser pattern projector 630 that projects a laser light pattern 631,such as a grid or pattern of lines and/or dots, at a predeterminedwavelength (λ₂) on the operative tissue or organ at the surgical site627. The camera 612 receives the patterned light as well as thereflected light output through the camera optics 632. The image sensor634 converts the received light into a digital signal.

The color RGB fusion circuit 616 also outputs signals to the imageoverlay controller 610 and a video input module 636 for reading thelaser light pattern 631 projected onto the targeted anatomy at thesurgical site 627 by the laser pattern projector 630. A processingmodule 638 processes the laser light pattern 631 and outputs a firstvideo output signal 640 representative of the distance to the visibletissue at the surgical site 627. The data is provided to the imageoverlay controller 610. The processing module 638 also outputs a secondvideo signal 642 representative of a three-dimensional rendered shape ofthe tissue or organ of the targeted anatomy at the surgical site.

The first and second video output signals 640, 642 include datarepresentative of the position of the critical structure on athree-dimensional surface model, which is provided to an integrationmodule 643. In combination with data from the video out processor 608 ofthe spectral control circuit 602, the integration module 643 candetermine the distance d_(A) (FIG. 1) to a buried critical structure(e.g. via triangularization algorithms 644), and the distance d_(A) canbe provided to the image overlay controller 610 via a video outprocessor 646. The foregoing conversion logic can encompass theconversion logic circuit 648 intermediate video monitors 652 and thecamera 624/laser pattern projector 630 positioned at the surgical site627.

Preoperative data 650 from a CT or MRI scan can be employed to registeror align certain three-dimensional deformable tissue in variousinstances. Such preoperative data 650 can be provided to the integrationmodule 643 and ultimately to the image overlay controller 610 so thatsuch information can be overlaid with the views from the camera 612 andprovided to the video monitors 652. Registration of preoperative data isfurther described herein and in the aforementionedcontemporaneously-filed U.S. Patent Applications, including U.S. patentapplication Ser. No. 16/128,195, titled INTEGRATION OF IMAGING DATA, nowU.S. Patent Application Publication No. 2020/0015907, for example, whichare incorporated by reference herein in their respective entireties.

The video monitors 652 can output the integrated/augmented views fromthe image overlay controller 610. A clinician can select and/or togglebetween different views on one or more monitors. On a first monitor 652a, the clinician can toggle between (A) a view in which athree-dimensional rendering of the visible tissue is depicted and (B) anaugmented view in which one or more hidden critical structures aredepicted over the three-dimensional rendering of the visible tissue. Ona second monitor 652 b, the clinician can toggle on distancemeasurements to one or more hidden critical structures and/or thesurface of visible tissue, for example.

The control system 600 and/or various control circuits thereof can beincorporated into various surgical visualization systems disclosedherein.

FIG. 12 illustrates a structured (or patterned) light system 700,according to at least one aspect of the present disclosure. As describedherein, structured light in the form of stripes or lines, for example,can be projected from a light source and/or projector 706 onto thesurface 705 of targeted anatomy to identify the shape and contours ofthe surface 705. A camera 720, which can be similar in various respectsto the imaging device 120 (FIG. 1), for example, can be configured todetect the projected pattern of light on the surface 705. The way thatthe projected pattern deforms upon striking the surface 705 allowsvision systems to calculate the depth and surface information of thetargeted anatomy.

In certain instances, invisible (or imperceptible) structured light canbe utilized, in which the structured light is used without interferingwith other computer vision tasks for which the projected pattern may beconfusing. For example, infrared light or extremely fast frame rates ofvisible light that alternate between two exact opposite patterns can beutilized to prevent interference. Structured light is further describedat en.wikipedia.org/wiki/Structured_light.

Referring now to FIG. 13, by way example to illustrate the concept ofhyperspectral imaging, a terrestrial hyperspectral imaging system 800 isshown. The terrestrial hyperspectral imaging system 800 is configured toimage terrestrial features or objects, such as soil, water, and/orvegetation, for example. The terrestrial hyperspectral imaging system700 includes a space-borne hyperspectral sensor 822 on a spacecraft 820to conduct hyperspectral imaging of a portion of the Earth's surface805. The spectral dimension includes several layers. Each pixel of theimages contains a sampled spectrum that is used to identify thematerials present in the pixel by their reflectance. The data can beconverted to graphical representations 850, 852, 854 of reflectance as afunction of wavelength for soil, water, and vegetation, respectively,for example. Terrestrial hyperspectral imaging is further described atwww.markelowitz.com/Hyperspectral.html.

Also by way example to illustrate the concept of hyperspectral imaging,FIG. 14 is a graphical representation 850 of hyperspectral signaturesfor various terrestrial features or objects, according to at least oneaspect of the present disclosure. Percent reflectance is shown along thevertical axis and wavelength (nm) is shown along the horizontal axis. Asshown, each object—pinewoods, grasslands, red sand pit, and siltywater—has a unique hyperspectral signature that can be used to identifythe object.

The hyperspectral imaging concepts described in connection with FIGS. 13and 14 may be employed for different materials that have differentwavelengths and bands of absorption, according to at least one aspect ofthe present disclosure. The following table illustrates the wavelengthsand bands of absorption for various materials. A first range ofwavelengths between 400 nm and 700 nm represents the visible lightspectrum. A second range of wavelengths between 700 nm and 1400 nmrepresents the near infrared (NIR) spectrum. A third range ofwavelengths between 1400 nm and 3000 nm represents a shortwave infrared(SWIR) spectrum. A first band centered at 1250 nm represents ironabsorption and leaf moisture content. A second band between 1500 nm and1750 nm represents plastics, fiberglass, and petroleum. A third bandbetween 200 nm and 2400 nm represents mineral ID.

TABLE 1 specifies wavelengths and bands of absorption for variousmaterials.

TABLE 1 Wavelength (nm) Region Band(s) Material  400-700 Visible 700-1400 NIR 1400-3000 SWIR 1-centered at 1250 Iron adsorption Leafmoisture content 2-1500-1750 Plastics Fiberglass Petroleum 3-200-2400 nmMineral ID

Referring now to FIGS. 15A-15C, as a further illustration ofhyperspectral imaging concepts, tests were conducted in which spectralimaging was applied to a fried egg 952. An image of the fried egg 952with a yellow egg yolk 954 and an egg white 956 surrounding the egg yolk954 is shown in FIG. 15A. A graphical representation 950 of spectralsignatures for the fried egg 952 are shown in FIG. 15B. Specifically,the graphical representation 950 shows absorption units versuswavelength (nm) for the egg yolk 954 and the egg white 956 of the friedegg 952. In FIG. 15C, a spectral image (in black-and-white) of the friedegg 952 is shown, in which the image is augmented to differentiatebetween the egg yolk portion and the egg white portion based on thehyperspectral signature data.

In various instances, hyperspectral imaging technology, as describedherein for illustrative purposes with respect to terrestrial featuresand objects and a fried egg, can be employed to identify signatures inanatomical structures in order to differentiate a critical structurefrom obscurants. Hyperspectral imaging technology may provide avisualization system that can provide a way to identify criticalstructures such as ureters and/or blood vessels, for example, especiallywhen those structures are obscured by fat, connective tissue, blood, orother organs, for example. The use of the difference in reflectance ofdifferent wavelengths in the infrared (IR) spectrum may be employed todetermine the presence of key structures versus obscurants. Referringnow to FIGS. 16-18, illustrative hyperspectral signatures for a ureter,an artery, and nerve tissue with respect to obscurants such as fat, lungtissue, and blood, for example, are depicted.

FIG. 16 is a graphical representation 1050 of an illustrative uretersignature versus obscurants. The plots represent reflectance as afunction of wavelength (nm) for wavelengths for fat, lung tissue, blood,and a ureter. FIG. 17 is a graphical representation 1052 of anillustrative artery signature versus obscurants. The plots representreflectance as a function of wavelength (nm) for fat, lung tissue,blood, and a vessel. FIG. 18 is a graphical representation 1054 of anillustrative nerve signature versus obscurants. The plots representreflectance as a function of wavelength (nm) for fat, lung tissue,blood, and a nerve.

In various instances, select wavelengths for spectral imaging can beidentified and utilized based on the anticipated critical structuresand/or obscurants at a surgical site (i.e. “selective spectral”imaging). By utilizing selective spectral imaging, the amount of timerequired to obtain the spectral image can be minimized such that theinformation can be obtained in real-time, or near real-time, andutilized intraoperatively. In various instances, the wavelengths can beselected by a clinician or by a control circuit based on input by theclinician. In certain instances, the wavelengths can be selected basedon machine learning and/or big data accessible to the control circuitvia a cloud, for example.

The foregoing application of spectral imaging to tissue can be utilizedintraoperatively to measure the distance between a waveform emitter anda critical structure that is obscured by tissue. In one aspect of thepresent disclosure, referring now to FIGS. 19 and 20, a time-of-flightsensor system 1104 utilizing waveforms 1124, 1125 is shown. Thetime-of-flight sensor system 1104 can be incorporated into the surgicalvisualization system 100 (FIG. 1) in certain instances. Thetime-of-flight sensor system 1104 includes a waveform emitter 1106 and awaveform receiver 1108 on the same surgical device 1102. The emittedwave 1124 extends to the critical structure 1101 from the emitter 1106and the received wave 1125 is reflected back to by the receiver 1108from the critical structure 1101. The surgical device 1102 is positionedthrough a trocar 1110 that extends into a cavity 1107 in a patient.

The waveforms 1124, 1125 are configured to penetrate obscuring tissue1103. For example, the wavelengths of the waveforms 1124, 1125 can be inthe NIR or SWIR spectrum of wavelengths. In one aspect, a spectralsignal (e.g. hyperspectral, multispectral, or selective spectral) or aphotoacoustic signal can be emitted from the emitter 1106 and canpenetrate the tissue 1103 in which the critical structure 1101 isconcealed. The emitted waveform 1124 can be reflected by the criticalstructure 1101. The received waveform 1125 can be delayed due to thedistance d between the distal end of the surgical device 1102 and thecritical structure 1101. In various instances, the waveforms 1124, 1125can be selected to target the critical structure 1101 within the tissue1103 based on the spectral signature of the critical structure 1101, asfurther described herein. In various instances, the emitter 1106 isconfigured to provide a binary signal on and off, as shown in FIG. 20,for example, which can be measured by the receiver 1108.

Based on the delay between the emitted wave 1124 and the received wave1125, the time-of-flight sensor system 1104 is configured to determinethe distance d (FIG. 19). A time-of-flight timing diagram 1130 for theemitter 1106 and the receiver 1108 of FIG. 19 is shown in FIG. 20. Thedelay is a function of the distance d and the distance d is given by:

$d = {\frac{ct}{2} \cdot \frac{q_{2}}{q_{1} + q_{2}}}$

where:

c=the speed of light;

t=length of pulse;

q₁=accumulated charge while light is emitted; and

q₂=accumulated charge while light is not being emitted.

As provided herein, the time-of-flight of the waveforms 1124, 1125corresponds to the distance din FIG. 19. In various instances,additional emitters/receivers and/or pulsing signals from the emitter1106 can be configured to emit a non-penetrating signal. Thenon-penetrating tissue can be configured to determine the distance fromthe emitter to the surface 1105 of the obscuring tissue 1103. In variousinstances, the depth of the critical structure 1101 can be determinedby:

d _(A) =d _(w) −d _(t).

where:

d_(A)=the depth of the critical structure 1101;

d_(w)=the distance from the emitter 1106 to the critical structure 1101(din FIG. 19); and

d_(t,)=the distance from the emitter 1106 (on the distal end of thesurgical device 1102) to the surface 1105 of the obscuring tissue 1103.

In one aspect of the present disclosure, referring now to FIG. 21, atime-of-flight sensor system 1204 utilizing waves 1224 a, 1224 b, 1224c, 1225 a, 1225 b, 1225 c is shown. The time-of-flight sensor system1204 can be incorporated into the surgical visualization system 100(FIG. 1) in certain instances. The time-of-flight sensor system 1204includes a waveform emitter 1206 and a waveform receiver 1208. Thewaveform emitter 1206 is positioned on a first surgical device 1202 a,and the waveform receiver 1208 is positioned on a second surgical device1202 b. The surgical devices 1202 a, 1202 b are positioned through theirrespective trocars 1210 a, 1210 b, respectively, which extend into acavity 1207 in a patient. The emitted waves 1224 a, 1224 b, 1224 cextend toward a surgical site from the emitter 1206 and the receivedwaves 1225 a, 1225 b, 1225 c are reflected back to the receiver 1208from various structures and/or surfaces at the surgical site.

The different emitted waves 1224 a, 1224 b, 1224 c are configured totarget different types of material at the surgical site. For example,the wave 1224 a targets the obscuring tissue 1203, the wave 1224 btargets a first critical structure 1201 a (e.g. a vessel), and the wave1224 c targets a second critical structure 1201 b (e.g. a canceroustumor). The wavelengths of the waves 1224 a, 1224 b, 1224 c can be inthe visible light, NIR, or SWIR spectrum of wavelengths. For example,visible light can be reflected off a surface 1205 of the tissue 1203 andNIR and/or SWIR waveforms can be configured to penetrate the surface1205 of the tissue 1203. In various aspects, as described herein, aspectral signal (e.g. hyperspectral, multispectral, or selectivespectral) or a photoacoustic signal can be emitted from the emitter1206. In various instances, the waves 1224 b, 1224 c can be selected totarget the critical structures 1201 a, 1201 b within the tissue 1203based on the spectral signature of the critical structure 1201 a, 1201b, as further described herein. Photoacoustic imaging is furtherdescribed herein and in the aforementioned contemporaneously-filed U.S.Patent Applications, which are incorporated by reference herein in theirrespective entireties.

The emitted waves 1224 a, 1224 b, 1224 c can be reflected off thetargeted material (i.e. the surface 1205, the first critical structure1201 a, and the second structure 1201 b, respectively). The receivedwaveforms 1225 a, 1225 b, 1225 c can be delayed due to the distancesd_(1a), d_(2a), d_(3a), d_(1b), d_(2b), d_(2c) indicated in FIG. 21.

In the time-of-flight sensor system 1204, in which the emitter 1206 andthe receiver 1208 are independently positionable (e.g., on separatesurgical devices 1202 a, 1202 b and/or controlled by separate roboticarms), the various distances d_(1a), d_(2a), d_(3a), d_(1b), d_(2b),d_(2c) can be calculated from the known position of the emitter 1206 andthe receiver 1208. For example, the positions can be known when thesurgical devices 1202 a, 1202 b are robotically-controlled. Knowledge ofthe positions of the emitter 1206 and the receiver 1208, as well as thetime of the photon stream to target a certain tissue and the informationreceived by the receiver 1208 of that particular response can allow adetermination of the distances d_(1a), d_(2a), d_(3a), d_(1b), d_(2b),d_(2c). In one aspect, the distance to the obscured critical structures1201 a, 1201 b can be triangulated using penetrating wavelengths.Because the speed of light is constant for any wavelength of visible orinvisible light, the time-of-flight sensor system 1204 can determine thevarious distances.

Referring still to FIG. 21, in various instances, in the view providedto the clinician, the receiver 1208 can be rotated such that the centerof mass of the target structure in the resulting images remainsconstant, i.e., in a plane perpendicular to the axis of a select targetstructures 1203, 1201 a, or 1201 b. Such an orientation can quicklycommunicate one or more relevant distances and/or perspectives withrespect to the critical structure. For example, as shown in FIG. 21, thesurgical site is displayed from a viewpoint in which the criticalstructure 1201 a is perpendicular to the viewing plane (i.e. the vesselis oriented in/out of the page). In various instances, such anorientation can be default setting; however, the view can be rotated orotherwise adjusted by a clinician. In certain instances, the cliniciancan toggle between different surfaces and/or target structures thatdefine the viewpoint of the surgical site provided by the imagingsystem.

In various instances, the receiver 1208 can be mounted on a trocar orcannula, such as the trocar 1210 b, for example, through which thesurgical device 1202 b is positioned. In other instances, the receiver1208 can be mounted on a separate robotic arm for which thethree-dimensional position is known. In various instances, the receiver1208 can be mounted on a movable arm that is separate from the robotthat controls the surgical device 1202 a or can be mounted to anoperating room (OR) table that is intraoperatively registerable to therobot coordinate plane. In such instances, the position of the emitter1206 and the receiver 1208 can be registerable to the same coordinateplane such that the distances can be triangulated from outputs from thetime-of-flight sensor system 1204.

Combining time-of-flight sensor systems and near-infrared spectroscopy(NIRS), termed TOF-NIRS, which is capable of measuring the time-resolvedprofiles of NIR light with nanosecond resolution can be found in thearticle titled TIME-OF-FLIGHT NEAR-INFRARED SPECTROSCOPY FORNONDESTRUCTIVE MEASUREMENT OF INTERNAL QUALITY IN GRAPEFRUIT, in theJournal of the American Society for Horticultural Science, May 2013 vol.138 no. 3 225-228, which is incorporated by reference herein in itsentirety, and is accessible atjournal.ashspublications.org/content/138/3/225.full.

In various instances, time-of-flight spectral waveforms are configuredto determine the depth of the critical structure and/or the proximity ofa surgical device to the critical structure. Moreover, the varioussurgical visualization systems disclosed herein include surface mappinglogic that is configured to create three-dimensional rendering of thesurface of the visible tissue. In such instances, even when the visibletissue obstructs a critical structure, the clinician can be aware of theproximity (or lack thereof) of a surgical device to the criticalstructure. In one instances, the topography of the surgical site isprovided on a monitor by the surface mapping logic. If the criticalstructure is close to the surface of the tissue, spectral imaging canconvey the position of the critical structure to the clinician. Forexample, spectral imaging may detect structures within 5 or 10 mm of thesurface. In other instances, spectral imaging may detect structures 10or 20 mm below the surface of the tissue. Based on the known limits ofthe spectral imaging system, the system is configured to convey that acritical structure is out-of-range if it is simply not detected by thespectral imaging system. Therefore, the clinician can continue to movethe surgical device and/or manipulate the tissue. When the criticalstructure moves into range of the spectral imaging system, the systemcan identify the structure and, thus, communicate that the structure iswithin range. In such instances, an alert can be provided when astructure is initially identified and/or moved further within apredefined proximity zone. In such instances, even non-identification ofa critical structure by a spectral imaging system with knownbounds/ranges can provide proximity information (i.e. the lack ofproximity) to the clinician.

Various surgical visualization systems disclosed herein can beconfigured to identify intraoperatively the presence of and/or proximityto critical structure(s) and to alert a clinician prior to damaging thecritical structure(s) by inadvertent dissection and/or transection. Invarious aspects, the surgical visualization systems are configured toidentify one or more of the following critical structures: ureters,bowel, rectum, nerves (including the phrenic nerve, recurrent laryngealnerve [RLN], promontory facial nerve, vagus nerve, and branchesthereof), vessels (including the pulmonary and lobar arteries and veins,inferior mesenteric artery [IMA] and branches thereof, superior rectalartery, sigmoidal arteries, and left colic artery), superior mesentericartery (SMA) and branches thereof (including middle colic artery, rightcolic artery, ilecolic artery), hepatic artery and branches thereof,portal vein and branches thereof, splenic artery/vein and branchesthereof, external and internal (hypogastric) ileac vessels, shortgastric arteries, uterine arteries, middle sacral vessels, and lymphnodes, for example. Moreover, the surgical visualization systems areconfigured to indicate proximity of surgical device(s) to the criticalstructure(s) and/or warn the clinician when surgical device(s) aregetting close to the critical structure(s).

Various aspects of the present disclosure provide intraoperativecritical structure identification (e.g., identification of ureters,nerves, and/or vessels) and instrument proximity monitoring. Forexample, various surgical visualization systems disclosed herein caninclude spectral imaging and surgical instrument tracking, which enablethe visualization of critical structures below the surface of thetissue, such as 1.0-1.5 cm below the surface of the tissue, for example.In other instances, the surgical visualization system can identifystructures less than 1.0 cm or more the 1.5 cm below the surface of thetissue. For example, even a surgical visualization system that canidentify structures only within 0.2 mm of the surface, for example, canbe valuable if the structure cannot otherwise be seen due to the depth.In various aspects, the surgical visualization system can augment theclinician's view with a virtual depiction of the critical structure as avisible white-light image overlay on the surface of visible tissue, forexample. The surgical visualization system can provide real-time,three-dimensional spatial tracking of the distal tip of surgicalinstruments and can provide a proximity alert when the distal tip of asurgical instrument moves within a certain range of the criticalstructure, such as within 1.0 cm of the critical structure, for example.

Various surgical visualization systems disclosed herein can identifywhen dissection is too close to a critical structure. Dissection may be“too close” to a critical structure based on the temperature (i.e. toohot within a proximity of the critical structure that may riskdamaging/heating/melting the critical structure) and/or based on tension(i.e. too much tension within a proximity of the critical structure thatmay risk damaging/tearing/pulling the critical structure). Such asurgical visualization system can facilitate dissection around vesselswhen skeletonizing the vessels prior to ligation, for example. Invarious instances, a thermal imaging camera can be utilized to read theheat at the surgical site and provide a warning to the clinician that isbased on the detected heat and the distance from a tool to thestructure. For example, if the temperature of the tool is over apredefined threshold (such as 120 degrees F., for example), an alert canbe provided to the clinician at a first distance (such as 10 mm, forexample), and if the temperature of the tool is less than or equal tothe predefined threshold, the alert can be provided to the clinician ata second distance (such as 5 mm, for example). The predefined thresholdsand/or warning distances can be default settings and/or programmable bythe clinician. Additionally or alternatively, a proximity alert can belinked to thermal measurements made by the tool itself, such as athermocouple that measures the heat in a distal jaw of a monopolar orbipolar dissector or vessel sealer, for example.

Various surgical visualization systems disclosed herein can provideadequate sensitivity with respect to a critical structure andspecificity to enable a clinician to proceed with confidence in a quickbut safe dissection based on the standard of care and/or device safetydata. The system can function intraoperatively and in real-time during asurgical procedure with minimal ionizing radiation risk to a patient ora clinician and, in various instances, no risk of ionizing radiationrisk to the patient or the clinician. Conversely, in a fluoroscopyprocedure, the patient and clinician(s) may be exposed to ionizingradiation via an X-ray beam, for example, that is utilized to view theanatomical structures in real-time.

Various surgical visualization system disclosed herein can be configuredto detect and identify one or more desired types of critical structuresin a forward path of a surgical device, such as when the path of thesurgical device is robotically controlled, for example. Additionally oralternatively, the surgical visualization system can be configured todetect and identify one or more types of critical structures in asurrounding area of the surgical device and/or in multipleplanes/dimensions, for example.

Various surgical visualization systems disclosed herein can be easy tooperate and/or interpret. Moreover, various surgical visualizationsystems can incorporate an “override” feature that allows the clinicianto override a default setting and/or operation. For example, a cliniciancan selectively turn off alerts from the surgical visualization systemand/or get closer to a critical structure than suggested by the surgicalvisualization system such as when the risk to the critical structure isless than risk of avoiding the area (e.g. when removing cancer around acritical structure the risk of leaving the cancerous tissue can begreater than the risk of damage to the critical structure).

Various surgical visualization systems disclosed herein can beincorporated into a surgical system and/or used during a surgicalprocedure with limited impact to the workflow. In other words,implementation of the surgical visualization system may not change theway the surgical procedure is implemented. Moreover, the surgicalvisualization system can be economical in comparison to the costs of aninadvertent transection. Data indicates the reduction in inadvertentdamage to a critical structure can drive incremental reimbursement.

Various surgical visualization systems disclosed herein can operate inreal-time, or near real-time, and far enough in advance to enable aclinician to anticipate critical structure(s). For example, a surgicalvisualization system can provide enough time to “slow down, evaluate,and avoid” in order to maximize efficiency of the surgical procedure.

Various surgical visualization systems disclosed herein may not requirea contrast agent, or dye, that is injected into tissue. For example,spectral imaging is configured to visualize hidden structuresintraoperatively without the use of a contrast agent or dye. In otherinstances, the contrast agent can be easier to inject into the properlayer(s) of tissue than other visualization systems. The time betweeninjection of the contrast agent and visualization of the criticalstructure can be less than two hours, for example.

Various surgical visualization systems disclosed herein can be linkedwith clinical data and/or device data. For example, data can provideboundaries for how close energy-enabled surgical devices (or otherpotentially damaging devices) should be from tissue that the surgeondoes not want to damage. Any data modules that interface with thesurgical visualization systems disclosed herein can be providedintegrally or separately from a robot to enable use with stand-alonesurgical devices in open or laparoscopic procedures, for example. Thesurgical visualization systems can be compatible with robotic surgicalsystems in various instances. For example, the visualizationimages/information can be displayed in a robotic console.

During a surgical procedure, a surgeon is oftentimes unable to clearlysee and/or identify every anatomical structure within the patient. Forexample, each particular surgical procedure can be associated with oneor more critical structures that are present in the environment and/orwithin the vicinity of the surgical site. If one or more criticalstructures are mistakenly encountered (e.g. dissected, stressed, orheated), complications such as excessive bleeding, tissue damage, and/ormajor vessel rupturing, for example, may occur. The various structureswithin the surgical site move through the surgical procedure in responseto application of an internal and/or external force such as actuation ofa surgical instrument, for example. The resulting movement may positionthe surgical instrument and/or other anatomical structures a potentiallydamaging distance from one or more critical structures.

A surgical visualization system can assist the surgeon during thesurgical procedure by identifying and/or following one or more criticalstructures. In various instances, the surgical visualization system isconfigured to capture relevant structural images of hidden criticalstructures with an image sensor and overlay the captured images on topof a live-feed of the surgical site. In various instances, the surgicalvisualization system comprises an automatic zoom feature configured toadjust the zoom, and thus, the overall view obtained by the image sensorto keep one or more critical structures within a viewing field of theimage sensor. In various instances the image sensor comprises a camera.In various instances, the surgical visualization system is configured todisplay relative distances between an object, such as, for example, asurgical instrument and one or more critical structures. By alerting thesurgeon of the location and/or presence of one or more criticalstructures, the surgical visualization system may assist in preventingmajor complications during surgical procedures, for example.

FIG. 22A depicts a display screen 1700 of a surgical visualizationsystem. In various instances, the surgical visualization system isconfigured to gather information regarding various structures fromwithin the surgical site in response to a user input. The user input cancorrespond to one or more critical structures selected for observationby the user. The surgical visualization system can be similar to thesurgical visualization system 100 (FIG. 1) and/or the hyperspectraltime-of-flight systems described with respect to FIGS. 19-21 in variousinstances. Using the surgical visualization system, the positions ofselected critical structures 1703 can be determined and displayed on thedisplay screen 1700. In various instances, the positions of the selectedcritical structures 1703 are continuously monitored and updatedthroughout the surgical procedure. For example, and as described ingreater detail herein, the surgical visualization system can include afirst light source configured to emit a plurality of spectral waves, asecond light source configured to emit a light pattern, and one or moresensors configured to detect visible light, molecular responses to thespectral waves, and/or the light pattern. Based on the output from oneor more sensors, a control circuit can determine a geometric surfaceprofile, i.e. topography, of the surgical site and one or more distanceswith respect to the surgical site. In certain instances, the controlcircuit can determine one or more distances to an at least partiallyconcealed structure. In various instances, differentiation measurementsof the critical structures within the surgical site are collected, suchas, for example, hyperspectral signatures, ultrasound responses, and/orphotoacoustic responses. Moreover, the geometric surface map and one ormore distances can be conveyed to a clinician through the display screen1700.

In various instances, an augmented view of the surgical site provided tothe clinician can provide a representation of the critical structurewithin the relevant context of the surgical site. For example, thesurgical visualization system can virtually augment the criticalstructure on the geometric surface map of the concealing and/orobstructing tissue similar to a line drawn on the ground to indicate agas line below the surface. Additionally or alternatively, the surgicalvisualization system can convey the proximity of one or more surgicaltools to the visible and obstructing tissue and/or to the at leastpartially concealed critical structure and/or the depth of the criticalstructure below the visible, obstructing tissue.

In various instances, the surgical visualization system comprises aplurality of visual modes, which determine which components from thesurgical site are displayed on the display screen 1700. The plurality ofvisual modes includes a hidden mode, wherein a live-feed from thesurgical site is displayed on the display screen 1700. The live-feed canbe provided from a three-dimensional camera, for example. Additionallyor alternatively, the live-feed can be provided as a digitalrepresentation of the topography of the visible tissue from a structuredlight system, as further described herein. The hidden criticalstructure(s) or hidden portions of the critical structures are notrepresented on the display screen 1700 in the hidden mode and, thus, arenot visible to the clinician. The plurality of visual modes furthercomprises a visible mode, wherein only the detected critical structuresare displayed on the display screen 1700. In other words, the live-feedof the surgical site is not provided, and the detected criticalstructures are displayed without the context of surrounding tissues andstructures. The plurality of visual modes further comprises acombination mode, wherein images of the detected critical structures areoverlaid on to the live-feed of the surgical site. Such a combinationmode provides context of the critical structures within the environmentof the surgical site. In various instances, only selected/taggedcritical structures may be visualized in the combination mode and thevisible mode, as further described herein.

As shown in FIG. 22A, the surgical visualization system is in a hiddenmode, as a first portion 1701 of the display screen 1700 is displayingimages of various critical structures 1703 without the context ofsurrounding tissues. The display screen 1700 comprises a second portion1702 comprising a selection menu to control various display options. Invarious instances, a user can select which critical structures aredisplayed on the display screen 1700 such as, for example, a vessel, atumor, a nerve, and/or the ureter. In various instances, the secondportion 1702 of the display screen 1700 can comprise a touch-sensitivedisplay that allows for the user to directly touch the screen to selectwhich features the user wishes to activate. In various instances, thedisplay screen 1700 is in signal communication with an external device,such as a handheld device or a computer that allows for a user to selectwhich features the user wishes to activate and/or which criticalstructures the user wants to see represented on the display screen 1700with a remotely-operated cursor 1706, for example. As shown in FIG. 22A,four relevant critical structures 1703 are displayed, as seen in thesecond portion 1702 of the display screen 1700. The reader willappreciate that less than four critical structures or more than fourcritical structures can be selected for monitoring. Additionally,different critical structures (anatomical structures, surgical devices,robotic end effectors, and/or staple lines, for example) can beselected.

The image sensor of the surgical visualization system is configured tobe able to move throughout the surgical site during a surgicalprocedure, thereby causing the overall image sensor view to change. If,as a result of the image sensor movement, for example, a portion of aselected critical structure 1703 is no longer within the view of theimage sensor, the surgical visualization system is configured to alertthe clinician. In various instances, the surgical visualization systemcan alert the clinician by displaying an arrow or marker on the displayscreen 1700 to indicate the general location of the selected criticalstructure 1703 even when the display screen is depicting a zoomed-inportion of the surgical site that does not include the selected criticalstructure, although any suitable manner for alerting the clinician isenvisioned.

In various instances, the surgical visualization system comprises animage sensor track mode, whose activation can be represented by a toggle1705 on the display screen 1700. When activated, the image sensor trackmode is configured to track the selected critical structure(s) and keepthe selected critical structure(s) within the image sensor view whilethe image sensor track mode remains activated. For example, the surgicalvisualization system is configured to automatically zoom in or out, orautomatically reposition itself, in response to a selected criticalstructure moving out of the image sensor view.

In various instances, in addition to selecting a relevant criticalstructure to display, the user can further tag a portion of a criticalstructure for more detailed monitoring. For example, if a surgeonanticipates that one or more surgical instruments 1704 will be heavilyused within a close proximity to a specific portion of a criticalstructure, the surgeon can tag the relevant portion, represented by theicon 1707 on the display screen 1700 of FIG. 22A. In various instances,the tagged icon 1707 will be continuously displayed as the image sensorview changes and/or the critical structure moves in response to internaland/or external forces.

Referring now to FIG. 22B, no critical structures are selected to bedepicted on the display screen 700, as seen in the second portion 1702of the display screen 1700. Furthermore, the surgical visualizationsystem is in a hidden mode, wherein the first portion 1701 of thedisplay screen 1700 displays a live-feed of the surgical site. Thus, thefirst portion 1701 displays the environment 1708 of the surgical sitewithout any structural information regarding at least partially hiddencritical structures. In various instances, an arrow or markerrepresentative of a previously-selected and out of view criticalstructure can still be depicted, regardless of the current visual modeof the surgical visualization system.

The combination visual mode of the surgical visualization system isactivated in FIG. 22C. Similar to FIG. 22A and as seen from theirselection on the second portion 1702 of the display 1700, four criticalstructures are selected to be depicted on the display screen 1700. Thecombination visual mode is configured to display the selected criticalstructures 1703 as an overlay on top of the live-feed of the surgicalsite environment 1708.

FIG. 23 depicts an algorithm 1710 for a surgical visualization system.Various surgical visualization systems disclosed herein can utilize thealgorithm 1710 of FIG. 23. For example, the surgical visualizationsystem 100 (FIG. 1) can utilize the algorithm 1710. Moreover, the readerwill readily appreciate that the algorithm 1710 of FIG. 23 can becombined with one or more additional algorithms described herein incertain instances. The decisions made by the surgical visualizationsystem can be implemented, for example, by a control circuit, such asthe control circuit 132 (FIG. 2), for example. At a block 1712, thecontrol circuit is configured to receive an input representing acritical structure selected for monitoring by a user. The controlcircuit is configured to determine the current visual mode of thesurgical visualization system at a block 1714. If the surgicalvisualization system is set to a visible mode 1714 a, the controlcircuit is configured to display only the selected critical structure(s)on a display screen at a block 1715. If the surgical visualizationsystem is set to a hidden mode 1714 b, the control circuit is configuredto display only the live-feed of the visible tissue and structures atthe surgical site on a display screen at a block 1716. If the surgicalvisualization system is set to a combination mode 1714 c, the controlcircuit is configured to display the selected critical structure(s)overlaid on the live-feed of the surgical site on a display screen at ablock 1717.

After determining the relevant structures to be displayed on the displayscreen, the control circuit is configured to determine whether an imagesensor track mode is activated at a block 1718. If the image sensortrack mode is activated at a block 1718 a, the control circuit isconfigured to track the tagged critical structures by keeping them inthe image sensor's view at a block 1719. In various instances, thecontrol circuit can keep the tagged critical structures within the imagesensor's view (the block 1719) by automatically adjusting the zoomand/or repositioning the image sensor to recapture the tagged criticalstructures within the image sensor's view. If the image sensor trackmode is not activated at a block 1718 b, the control circuit isconfigured to allow the image sensor to freely move and/or adjust at ablock 1720 without concern over which structures are displayed on thedisplay screen. In various instances, the control circuit is configuredto continuously monitor the current visual mode 1714 of the surgicalvisualization system and/or the status of the image sensor track mode atthe block 1718, as the user may switch between various modes during thesurgical procedure.

In various instances, the surgical visualization system is configured toconvey the proximity of one or more surgical tools to the visible andobstructing tissue and/or to the at least partially concealed criticalstructure and/or the depth of the critical structure below the visible,obstructing tissue. Referring now to FIG. 24A, a display screen 1730 ofa surgical visualization system is depicted. The surgical visualizationsystem can be similar to the surgical visualization system 100 (FIG. 1)and/or the hyperspectral time-of-flight systems described with respectto FIGS. 19-21 in various instances. Moreover, a control circuit, suchas the control circuit 132 (FIG. 2), for example, can be configured toreceive a user input regarding one or more critical structures 1733 tomonitor. The surgical visualization system is configured to determinethe positions of the selected critical structures 1733 and overlay theselected critical structures 1733 over a live-feed 1738 of the surgicalsite. In various instances, the positions of the selected criticalstructures 1733 are continuously monitored and updated throughout thesurgical procedure.

As discussed above, the user may determine that a particular portion ofa selected critical structure 1733 needs to be more closely monitored.In such instances, the user can tag the relevant portion, represented bythe icon 1737 on a first portion 1731 of the display screen 1730. Invarious instances, the tagged icon 1737 can be continuously displayed asthe image sensor view changes and/or the critical structure moves inresponse to internal and/or external forces. In various instances, asecond portion 1732 of the display screen 1730 depicts at least oneproximity scale 1735, 1736 representing a distance from one or moresurgical instruments 1734 to a selected critical structure 1733. In atleast one instance, a proximity scale 1735 represents the distanced_(lag) between the portion of the critical structure tagged by the icon1737 for close monitoring and one or more surgical instruments 1734. Inat least one instance, another proximity scale 1736 represents theminimum distance d_(min) between one or more surgical instruments 1734and any portion of a selected critical structure 1733.

Referring now to FIG. 24B, as the image sensor of the surgicalvisualization system zooms in on a particular surgical site, theselected critical structures may no longer be visible within the imagesensor view, and thus, may no longer be depicted on the display screen1730. However, the proximity scales 1735, 1736 are still present on thesecond portion 1732 of the display screen 1730 to provide the user withsome information relating to the location and/or orientation of theselected critical structures 1733 with respect to one or more surgicalinstruments 1734. Additionally, the first portion 1731 of the displayscreen 1730 can depict an arrow 1739 (FIG. 24B) or other markerindicating the position of the critical structure out of the zoomed-inportion of the surgical site shown on the display screen 1730.

FIG. 25 depicts an algorithm 1740 for a surgical visualization system.Various surgical visualization systems disclosed herein can utilize thealgorithm 1740 of FIG. 25. For example, the surgical visualizationsystem 100 (FIG. 1) can utilize the algorithm 1740. Moreover, the readerwill readily appreciate that the algorithm 1740 of FIG. 25 can becombined with one or more additional algorithms described herein incertain instances. The decisions made by the surgical visualizationsystem can be implemented, for example, by a control circuit, such asthe control circuit 132 (FIG. 2), for example. The control circuit isconfigured to receive an input at a block 1742 representing a criticalstructure selected for monitoring by a user. The control circuit isconfigured to determine a position (e.g. location and/or orientation) ata block 1744 of the selected critical structure 1742. The controlcircuit is further configured to determine a position of one or moresurgical instruments at a block 1746 within the surgical site. Afterdetermining the positions of the selected critical structure 1742 andone or more surgical instruments at the blocks 1744 and 1746, thecontrol circuit is configured to calculate a minimum distance at block1748 between one or more surgical instruments and the selected criticalstructure. In various instances, the control circuit is configured tocontinuously monitor the position of the selected critical structure1742 throughout the surgical procedure and calculate the minimumdistance 1748 as necessary. Additionally or alternatively, the controlcircuit is configured to continuously monitor the position of one ormore surgical instruments (block 1746) throughout the surgical procedureand calculate the minimum distance (block 1748) as necessary.

FIG. 26 depicts an algorithm 1750 for a surgical visualization system.Various surgical visualization systems disclosed herein can utilize thealgorithm 1750 of FIG. 26. For example, the surgical visualizationsystem 100 (FIG. 1) can utilize the algorithm 1750. Moreover, the readerwill readily appreciate that the algorithm 1750 of FIG. 26 can becombined with one or more additional algorithms described herein incertain instances. The decisions made by the surgical visualizationsystem can be implemented, for example, by a control circuit, such asthe control circuit 132 (FIG. 2), for example. The control circuit isconfigured to receive an input 1751 representing a critical structureselected for monitoring by a user.

The control circuit is configured to determine a position (e.g. locationand/or orientation) 1752 of the selected critical structure at a block1751. In various instances, the control circuit is configured to displaythe determined orientation of the selected critical structure 1751 to auser on a display screen at a block 1752. In various instances, thecontrol circuit is configured to receive a second input representing aspecific portion of the selected critical structure that the user wantsto more closely monitor during the surgical procedure at a block 1753.At a block 1754, the control circuit is further configured to determinea position of one or more surgical instruments within the surgical site.After determining the positions of the selected critical structure atthe block 1751 and one or more surgical instruments at the block 1754,the control circuit is configured to calculate and display a distancebetween one or more surgical instruments and the tagged portion of theselected critical structure at a block 1755. Additionally, the controlcircuit is configured to calculate and display the minimum distancebetween one or more surgical instruments and the selected criticalstructure at a block 1756. In various instances, the control circuit isconfigured to continuously calculate and display the distance betweenone or more surgical instruments and the tagged portion of the selectedcritical structure (block 1755). Additionally or alternatively, thecontrol circuit is configured to continuously monitor the position ofthe selected critical structure (the block 1752) throughout the surgicalprocedure and calculate the minimum distance 1756 as necessary.Furthermore, additionally or alternatively, the control circuit isconfigured to continuously monitor the position of one or more surgicalinstruments (the block 1754) throughout the surgical procedure andcalculate the minimum distance (the block 1756) as necessary.

Example Clinical Applications

Various surgical visualization systems disclosed herein may be employedin one or more of the following clinical applications. The followingclinical applications are non-exhaustive and merely illustrativeapplications for one or more of the various surgical visualizationsystems disclosed herein.

A surgical visualization system, as disclosed herein, can be employed ina number of different types of procedures for different medicalspecialties, such as urology, gynecology, oncology, colorectal,thoracic, bariatric/gastric, and hepato-pancreato-biliary (HPB), forexample. In urological procedures, such as a prostatectomy, for example,the ureter may be detected in fat or connective tissue and/or nerves maybe detected in fat, for example. In gynecological oncology procedures,such as a hysterectomy, for example, and in colorectal procedures, suchas a low anterior resection (LAR) procedure, for example, the ureter maybe detected in fat and/or in connective tissue, for example. In thoracicprocedures, such as a lobectomy, for example, a vessel may be detectedin the lung or in connective tissue and/or a nerve may be detected inconnective tissue (e.g., an esophagostomy). In bariatric procedures, avessel may be detected in fat. In HPB procedures, such as a hepatectomyor pancreatectomy, for example, a vessel may be detected in fat(extrahepatic), in connective tissue (extrahepatic), and the bile ductmay be detected in parenchyma (liver or pancreas) tissue.

In one example, a clinician may want to remove an endometrial myoma.From a preoperative magnetic resonance imaging (MRI) scan, the clinicianmay know that the endometrial myoma is located on the surface of thebowel. Therefore, the clinician may want to know, intraoperatively, whattissue constitute a portion of the bowel and what tissue constitutes aportion of the rectum. In such instances, a surgical visualizationsystem, as disclosed herein, can indicate the different types of tissue(bowel versus rectum) and convey that information to a clinician via animaging system. Moreover, the imaging system can determine andcommunicate the proximity of a surgical device to the select tissue. Insuch instances, the surgical visualization system can provide increasedprocedural efficiency without critical complications.

In another example, a clinician (e.g. a gynecologist) may stay away fromcertain anatomic regions to avoid getting too close to criticalstructures and, thus, the clinician may not remove all of theendometriosis, for example. A surgical visualization system, asdisclosed herein, can enable the gynecologist to mitigate the risk ofgetting too close to the critical structure such that the gynecologistcan get close enough with the surgical device to remove all theendometriosis, which can improve the patient outcomes (democratizingsurgery). Such a system can enable the surgeon to “keep moving” duringthe surgical procedure instead of repeatedly stopping and restarting inorder to identify areas to avoid, especially during the application oftherapeutic energy such as ultrasonic or electrosurgical energy, forexample. In gynecological applications, uterine arteries and ureters areimportant critical structures and the system may be particularly usefulfor hysterectomy and endometriosis procedures given the presentationand/or thickness of tissue involved.

In another example, a clinician may risk dissection of a vessel at alocation that is too proximal and, thus, which can affect blood supplyto a lobe other than the target lobe. Moreover, anatomic differencesfrom patient to patient may lead to dissection of a vessel (e.g. abranch) that affects a different lobe based on the particular patient. Asurgical visualization system, as disclosed herein, can enable theidentification of the correct vessel at the desired location, whichenables the clinician to dissect with appropriate anatomic certainty.For example, the system can confirm that the correct vessel is in thecorrect place and then the clinician can safely divide the vessel.

In another example, a clinician may make multiple dissections beforedissecting at the best location due to uncertainty about the anatomy ofthe vessel. However, it is desirable to dissect in the best location inthe first instance because more dissection can increase the risk ofbleeding. A surgical visualization system, as disclosed herein, canminimize the number of dissections by indicating the correct vessel andthe best location for dissection. Ureters and cardinal ligaments, forexample, are dense and provide unique challenges during dissection. Insuch instances, it can be especially desirable to minimize the number ofdissections.

In another example, a clinician (e.g. a surgical oncologist) removingcancerous tissue may want to know the identification of criticalstructures, localization of the cancer, staging of the cancer, and/or anevaluation of tissue health. Such information is beyond what a cliniciansees with the “naked eye”. A surgical visualization system, as disclosedherein, can determine and/or convey such information to the clinicianintraoperatively to enhance intraoperative decision making and improvesurgical outcomes. In certain instances, the surgical visualizationsystem can be compatible with minimally invasive surgery (MIS), opensurgery, and/or robotic approaches using either an endoscope orexoscope, for example.

In another example, a clinician (e.g. a surgical oncologist) may want toturn off one or more alerts regarding the proximity of a surgical toolto one or more critical structure to avoid being overly conservativeduring a surgical procedure. In other instances, the clinician may wantto receive certain types of alerts, such as haptic feedback (e.g.vibrations/buzzing) to indicate proximity and/or or “no fly zones” tostay sufficiently far away from one or more critical structures. Asurgical visualization system, as disclosed herein, can provideflexibility based on the experience of the clinician and/or desiredaggressiveness of the procedure, for example. In such instances, thesystem provides a balance between “knowing too much” and “knowingenough” to anticipate and avoid critical structures. The surgicalvisualization system can assist in planning the next step(s) during asurgical procedure.

EXAMPLES

Various aspects of the subject matter described herein are set out inthe following numbered examples.

Example 1—A surgical visualization system comprising a robotic toolcomprising an image sensor. The image sensor defines a field of view.The surgical visualization system further comprises a display screen.The surgical visualization system further comprises a control circuitcommunicatively coupled to the robotic tool, the image sensor, and thedisplay screen. The surgical visualization system further comprises amemory communicatively coupled to the control circuit. The memory storesprogram instructions which, when executed, cause the control circuit toreceive a first input corresponding to a structure selected formonitoring, receive information from the image sensor related to aposition of the structure, provide a signal to the display screencorresponding to the position of the structure, and adjust the imagesensor to maintain the position of the structure within the field ofview.

Example 2—The surgical visualization system of Example 1, wherein thestructure comprises an embedded structure.

Example 3—The surgical visualization system of Examples 1 or 2, whereinadjusting the image sensor comprises adjusting a zoom level of the imagesensor.

Example 4—The surgical visualization system of Examples 1, 2, or 3,wherein adjusting the image sensor comprises adjusting an orientation ofthe image sensor.

Example 5—The surgical visualization system of Examples 1, 2, 3, or 4,wherein adjusting the image sensor comprises moving the robotic tool toa different position.

Example 6—The surgical visualization system of Examples 1, 2, 3, 4, or5, wherein the memory further comprises program instructions which, whenexecuted, cause the control circuit to provide an alert to a clinicianwhen the structure is positioned outside of the field of view.

Example 7—The surgical visualization system of Examples 1, 2, 3, 4, 5,or 6, wherein the structure is not displayed on the display screen whenat least a portion of the structure is positioned outside of the fieldof view.

Example 8—A surgical visualization system comprising a first sourceconfigured to emit a plurality of spectral light waves configured topenetrate a tissue. The surgical visualization system further comprisesa second source configured to emit a structured light pattern onto asurface of the tissue. The surgical visualization system furthercomprises an image sensor configured to detect at least one of thereflected plurality of spectral light waves and the reflected structuredlight pattern. The surgical visualization system further comprises adisplay screen, a control circuit, and a memory. The control circuit iscommunicatively coupled to the first source, the second source, theimage sensor, and the display screen. The memory is communicativelycoupled to the control circuit. The memory stores program instructionswhich, when executed, cause the control circuit to receive a first inputcorresponding to a structure selected for tracking, cause the firstsource to emit the plurality of spectral light waves, cause the secondsource to emit the structured light pattern, receive information fromthe image sensor corresponding to the structured light pattern on thesurface of the tissue and the spectral light waves reflected from thestructure, identify the structure from the information received by theimage sensor, provide a signal to the display screen corresponding tothe identified structure, and adjust the image sensor when the structureis no longer captured by the image sensor.

Example 9—The surgical visualization system of Example 8, wherein thestructure is at least partially hidden.

Example 10—The surgical visualization system of Examples 8 or 8, whereinadjusting the image sensor comprises adjusting a zoom level of the imagesensor.

Example 11—The surgical visualization system of Examples 8, 9, or 10,wherein adjusting the image sensor comprises adjusting an orientation ofthe image sensor.

Example 12—The surgical visualization system of Examples 8, 9, 10, or11, wherein adjusting the image sensor comprises adjusting a location ofthe image sensor.

Example 13—The surgical visualization system of Examples 8, 9, 10, 11,or 12, wherein the structure is no longer captured by the image sensorwhen at least a portion of the structure is positioned outside of afield of view of the image sensor.

Example 14—The surgical visualization system of Examples 8, 9, 10, 11,12, or 13, wherein the memory further comprises program instructionswhich, when executed, cause the control circuit to provide an alert whenthe structure is no longer captured by the image sensor.

Example 15—A surgical visualization system comprising an image sensorconfigured to image an embedded structure at least partially embeddedwithin a visible structure. The image sensor defines a field of view.The surgical visualization system further comprises a display screen, acontrol circuit, and a memory. The control circuit is communicativelycoupled to the image sensor and the display screen. The control circuitcomprises an image overlay controller. The memory is communicativelycoupled to the control circuit. The memory stores program instructionswhich, when executed, cause the control circuit to receive a first inputcorresponding to the embedded structure selected for monitoring, receiveinformation from the image sensor related to a position of the embeddedstructure, provide a live-feed video signal of the visible structure tothe image overlay controller, and provide a live-feed video signal ofthe position of the embedded structure to the image overlay controller.The image overlay controller is configured to overlay the position ofthe embedded structure on top of the visible structure. The memorystores program instructions which, when executed, further cause thecontrol circuit to determine a distance with respect to the embeddedstructure and provide a signal indicative of the distance to the displayscreen.

Example 16—The surgical visualization system of Example 15, wherein thememory further comprises program instructions which, when executed,cause the control circuit to provide a zoomed-in portion of thelive-feed video signal of the visible structure to the image overlaycontroller, and provide an indication of the position of the embeddedstructure outside of the zoomed-in portion.

Example 17—The surgical visualization system of Examples 15 or 16,wherein the distance comprises a distance between the embedded structureand a surgical end effector.

Example 18—The surgical visualization system of Examples 15, 16, or 17,wherein the memory further comprises program instructions which, whenexecuted, cause the control circuit to adjust the image sensor when theembedded structure is no longer positioned within the field of view.

Example 19—The surgical visualization system of Examples 15, 16, 17, or18, further comprising a robotic tool, wherein the image sensor ismounted on the robotic tool, and wherein the robotic tool isautomatically moved to a different position when the embedded structureis no longer positioned within the field of view.

Example 20—The surgical visualization system of Examples 15, 16, 17, 18,or 19, wherein the memory further comprises program instructions which,when executed, cause the control circuit to provide an alert when theembedded structure is positioned outside of the field of view of theimage sensor.

While several forms have been illustrated and described, it is not theintention of Applicant to restrict or limit the scope of the appendedclaims to such detail. Numerous modifications, variations, changes,substitutions, combinations, and equivalents to those forms may beimplemented and will occur to those skilled in the art without departingfrom the scope of the present disclosure. Moreover, the structure ofeach element associated with the described forms can be alternativelydescribed as a means for providing the function performed by theelement. Also, where materials are disclosed for certain components,other materials may be used. It is therefore to be understood that theforegoing description and the appended claims are intended to cover allsuch modifications, combinations, and variations as falling within thescope of the disclosed forms. The appended claims are intended to coverall such modifications, variations, changes, substitutions,modifications, and equivalents.

The foregoing detailed description has set forth various forms of thedevices and/or processes via the use of block diagrams, flowcharts,and/or examples. Insofar as such block diagrams, flowcharts, and/orexamples contain one or more functions and/or operations, it will beunderstood by those within the art that each function and/or operationwithin such block diagrams, flowcharts, and/or examples can beimplemented, individually and/or collectively, by a wide range ofhardware, software, firmware, or virtually any combination thereof.Those skilled in the art will recognize that some aspects of the formsdisclosed herein, in whole or in part, can be equivalently implementedin integrated circuits, as one or more computer programs running on oneor more computers (e.g., as one or more programs running on one or morecomputer systems), as one or more programs running on one or moreprocessors (e.g., as one or more programs running on one or moremicroprocessors), as firmware, or as virtually any combination thereof,and that designing the circuitry and/or writing the code for thesoftware and or firmware would be well within the skill of one of skillin the art in light of this disclosure. In addition, those skilled inthe art will appreciate that the mechanisms of the subject matterdescribed herein are capable of being distributed as one or more programproducts in a variety of forms, and that an illustrative form of thesubject matter described herein applies regardless of the particulartype of signal bearing medium used to actually carry out thedistribution.

Instructions used to program logic to perform various disclosed aspectscan be stored within a memory in the system, such as dynamic randomaccess memory (DRAM), cache, flash memory, or other storage.Furthermore, the instructions can be distributed via a network or by wayof other computer readable media. Thus a machine-readable medium mayinclude any mechanism for storing or transmitting information in a formreadable by a machine (e.g., a computer), but is not limited to, floppydiskettes, optical disks, compact disc, read-only memory (CD-ROMs), andmagneto-optical disks, read-only memory (ROMs), random access memory(RAM), erasable programmable read-only memory (EPROM), electricallyerasable programmable read-only memory (EEPROM), magnetic or opticalcards, flash memory, or a tangible, machine-readable storage used in thetransmission of information over the Internet via electrical, optical,acoustical or other forms of propagated signals (e.g., carrier waves,infrared signals, digital signals, etc.). Accordingly, thenon-transitory computer-readable medium includes any type of tangiblemachine-readable medium suitable for storing or transmitting electronicinstructions or information in a form readable by a machine (e.g., acomputer).

As used in any aspect herein, the term “control circuit” may refer to,for example, hardwired circuitry, programmable circuitry (e.g., acomputer processor including one or more individual instructionprocessing cores, processing unit, processor, microcontroller,microcontroller unit, controller, digital signal processor (DSP),programmable logic device (PLD), programmable logic array (PLA), orfield programmable gate array (FPGA)), state machine circuitry, firmwarethat stores instructions executed by programmable circuitry, and anycombination thereof. The control circuit may, collectively orindividually, be embodied as circuitry that forms part of a largersystem, for example, an integrated circuit (IC), an application-specificintegrated circuit (ASIC), a system on-chip (SoC), desktop computers,laptop computers, tablet computers, servers, smart phones, etc.Accordingly, as used herein “control circuit” includes, but is notlimited to, electrical circuitry having at least one discrete electricalcircuit, electrical circuitry having at least one integrated circuit,electrical circuitry having at least one application specific integratedcircuit, electrical circuitry forming a general purpose computing deviceconfigured by a computer program (e.g., a general purpose computerconfigured by a computer program which at least partially carries outprocesses and/or devices described herein, or a microprocessorconfigured by a computer program which at least partially carries outprocesses and/or devices described herein), electrical circuitry forminga memory device (e.g., forms of random access memory), and/or electricalcircuitry forming a communications device (e.g., a modem, communicationsswitch, or optical-electrical equipment). Those having skill in the artwill recognize that the subject matter described herein may beimplemented in an analog or digital fashion or some combination thereof.

As used in any aspect herein, the term “logic” may refer to an app,software, firmware and/or circuitry configured to perform any of theaforementioned operations. Software may be embodied as a softwarepackage, code, instructions, instruction sets and/or data recorded onnon-transitory computer readable storage medium. Firmware may beembodied as code, instructions or instruction sets and/or data that arehard-coded (e.g., nonvolatile) in memory devices.

As used in any aspect herein, the terms “component,” “system,” “module”and the like can refer to a computer-related entity, either hardware, acombination of hardware and software, software, or software inexecution.

As used in any aspect herein, an “algorithm” refers to a self-consistentsequence of steps leading to a desired result, where a “step” refers toa manipulation of physical quantities and/or logic states which may,though need not necessarily, take the form of electrical or magneticsignals capable of being stored, transferred, combined, compared, andotherwise manipulated. It is common usage to refer to these signals asbits, values, elements, symbols, characters, terms, numbers, or thelike. These and similar terms may be associated with the appropriatephysical quantities and are merely convenient labels applied to thesequantities and/or states.

A network may include a packet switched network. The communicationdevices may be capable of communicating with each other using a selectedpacket switched network communications protocol. One examplecommunications protocol may include an Ethernet communications protocolwhich may be capable permitting communication using a TransmissionControl Protocol/Internet Protocol (TCP/IP). The Ethernet protocol maycomply or be compatible with the Ethernet standard published by theInstitute of Electrical and Electronics Engineers (IEEE) titled “IEEE802.3 Standard”, published in December, 2008 and/or later versions ofthis standard. Alternatively or additionally, the communication devicesmay be capable of communicating with each other using an X.25communications protocol. The X.25 communications protocol may comply orbe compatible with a standard promulgated by the InternationalTelecommunication Union-Telecommunication Standardization Sector(ITU-T). Alternatively or additionally, the communication devices may becapable of communicating with each other using a frame relaycommunications protocol. The frame relay communications protocol maycomply or be compatible with a standard promulgated by ConsultativeCommittee for International Telegraph and Telephone (CCITT) and/or theAmerican National Standards Institute (ANSI). Alternatively oradditionally, the transceivers may be capable of communicating with eachother using an Asynchronous Transfer Mode (ATM) communications protocol.The ATM communications protocol may comply or be compatible with an ATMstandard published by the ATM Forum titled “ATM-MPLS NetworkInterworking 2.0” published August 2001, and/or later versions of thisstandard. Of course, different and/or after-developedconnection-oriented network communication protocols are equallycontemplated herein.

Unless specifically stated otherwise as apparent from the foregoingdisclosure, it is appreciated that, throughout the foregoing disclosure,discussions using terms such as “processing,” “computing,”“calculating,” “determining,” “displaying,” or the like, refer to theaction and processes of a computer system, or similar electroniccomputing device, that manipulates and transforms data represented asphysical (electronic) quantities within the computer system's registersand memories into other data similarly represented as physicalquantities within the computer system memories or registers or othersuch information storage, transmission or display devices.

One or more components may be referred to herein as “configured to,”“configurable to,” “operable/operative to,” “adapted/adaptable,” “ableto,” “conformable/conformed to,” etc. Those skilled in the art willrecognize that “configured to” can generally encompass active-statecomponents and/or inactive-state components and/or standby-statecomponents, unless context requires otherwise.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” refers to the portion closest to the clinician andthe term “distal” refers to the portion located away from the clinician.It will be further appreciated that, for convenience and clarity,spatial terms such as “vertical”, “horizontal”, “up”, and “down” may beused herein with respect to the drawings. However, surgical instrumentsare used in many orientations and positions, and these terms are notintended to be limiting and/or absolute.

Those skilled in the art will recognize that, in general, terms usedherein, and especially in the appended claims (e.g., bodies of theappended claims) are generally intended as “open” terms (e.g., the term“including” should be interpreted as “including but not limited to,” theterm “having” should be interpreted as “having at least,” the term“includes” should be interpreted as “includes but is not limited to,”etc.). It will be further understood by those within the art that if aspecific number of an introduced claim recitation is intended, such anintent will be explicitly recited in the claim, and in the absence ofsuch recitation no such intent is present. For example, as an aid tounderstanding, the following appended claims may contain usage of theintroductory phrases “at least one” and “one or more” to introduce claimrecitations. However, the use of such phrases should not be construed toimply that the introduction of a claim recitation by the indefinitearticles “a” or “an” limits any particular claim containing suchintroduced claim recitation to claims containing only one suchrecitation, even when the same claim includes the introductory phrases“one or more” or “at least one” and indefinite articles such as “a” or“an” (e.g., “a” and/or “an” should typically be interpreted to mean “atleast one” or “one or more”); the same holds true for the use ofdefinite articles used to introduce claim recitations.

In addition, even if a specific number of an introduced claim recitationis explicitly recited, those skilled in the art will recognize that suchrecitation should typically be interpreted to mean at least the recitednumber (e.g., the bare recitation of “two recitations,” without othermodifiers, typically means at least two recitations, or two or morerecitations). Furthermore, in those instances where a conventionanalogous to “at least one of A, B, and C, etc.” is used, in generalsuch a construction is intended in the sense one having skill in the artwould understand the convention (e.g., “a system having at least one ofA, B, and C” would include but not be limited to systems that have Aalone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). In those instances where aconvention analogous to “at least one of A, B, or C, etc.” is used, ingeneral such a construction is intended in the sense one having skill inthe art would understand the convention (e.g., “a system having at leastone of A, B, or C” would include but not be limited to systems that haveA alone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). It will be furtherunderstood by those within the art that typically a disjunctive wordand/or phrase presenting two or more alternative terms, whether in thedescription, claims, or drawings, should be understood to contemplatethe possibilities of including one of the terms, either of the terms, orboth terms unless context dictates otherwise. For example, the phrase “Aor B” will be typically understood to include the possibilities of “A”or “B” or “A and B.”

With respect to the appended claims, those skilled in the art willappreciate that recited operations therein may generally be performed inany order. Also, although various operational flow diagrams arepresented in a sequence(s), it should be understood that the variousoperations may be performed in other orders than those which areillustrated, or may be performed concurrently. Examples of suchalternate orderings may include overlapping, interleaved, interrupted,reordered, incremental, preparatory, supplemental, simultaneous,reverse, or other variant orderings, unless context dictates otherwise.Furthermore, terms like “responsive to,” “related to,” or otherpast-tense adjectives are generally not intended to exclude suchvariants, unless context dictates otherwise.

It is worthy to note that any reference to “one aspect,” “an aspect,”“an exemplification,” “one exemplification,” and the like means that aparticular feature, structure, or characteristic described in connectionwith the aspect is included in at least one aspect. Thus, appearances ofthe phrases “in one aspect,” “in an aspect,” “in an exemplification,”and “in one exemplification” in various places throughout thespecification are not necessarily all referring to the same aspect.Furthermore, the particular features, structures or characteristics maybe combined in any suitable manner in one or more aspects.

Any patent application, patent, non-patent publication, or otherdisclosure material referred to in this specification and/or listed inany Application Data Sheet is incorporated by reference herein, to theextent that the incorporated materials is not inconsistent herewith. Assuch, and to the extent necessary, the disclosure as explicitly setforth herein supersedes any conflicting material incorporated herein byreference. Any material, or portion thereof, that is said to beincorporated by reference herein, but which conflicts with existingdefinitions, statements, or other disclosure material set forth hereinwill only be incorporated to the extent that no conflict arises betweenthat incorporated material and the existing disclosure material.

In summary, numerous benefits have been described which result fromemploying the concepts described herein. The foregoing description ofthe one or more forms has been presented for purposes of illustrationand description. It is not intended to be exhaustive or limiting to theprecise form disclosed. Modifications or variations are possible inlight of the above teachings. The one or more forms were chosen anddescribed in order to illustrate principles and practical application tothereby enable one of ordinary skill in the art to utilize the variousforms and with various modifications as are suited to the particular usecontemplated. It is intended that the claims submitted herewith definethe overall scope.

1-14. (canceled)
 15. A surgical visualization system, comprising: animage sensor configured to image an embedded structure at leastpartially embedded within a visible structure, wherein the image sensordefines a field of view; a display screen; a control circuitcommunicatively coupled to the image sensor and the display screen,wherein the control circuit comprises an image overlay controller; and amemory communicatively coupled to the control circuit, wherein thememory stores program instructions which, when executed, cause thecontrol circuit to: receive a first input corresponding to the embeddedstructure selected for monitoring; receive information from the imagesensor related to a position of the embedded structure; provide alive-feed video signal of the visible structure to the image overlaycontroller; provide a live-feed video signal of the position of theembedded structure to the image overlay controller, wherein the imageoverlay controller is configured to overlay the position of the embeddedstructure on top of the visible structure; determine a distance withrespect to the embedded structure; and provide a signal indicative ofthe distance to the display screen.
 16. The surgical visualizationsystem of claim 15, wherein the memory further comprises programinstructions which, when executed, cause the control circuit to: providea zoomed-in portion of the live-feed video signal of the visiblestructure to the image overlay controller; and provide an indication ofthe position of the embedded structure outside of the zoomed-in portion.17. The surgical visualization system of claim 15, wherein the distancecomprises a distance between the embedded structure and a surgical endeffector.
 18. The surgical visualization system of claim 15, wherein thememory further comprises program instructions which, when executed,cause the control circuit to adjust the image sensor when the embeddedstructure is no longer positioned within the field of view.
 19. Thesurgical visualization system of claim 15, further comprising a robotictool, wherein the image sensor is mounted on the robotic tool, andwherein the robotic tool is automatically moved to a different positionwhen the embedded structure is no longer positioned within the field ofview.
 20. The surgical visualization system of claim 15, wherein thememory further comprises program instructions which, when executed,cause the control circuit to provide an alert when the embeddedstructure is positioned outside of the field of view of the imagesensor.